Individual
MARY E EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
121 E CEDAR ST, FLORENCE, SC 29506-2576
(843) 661-3426
Mailing address
PO BOX 1004, JOHNSONVILLE, SC 29555-1004
(843) 472-9752
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2857
SC
Other
Enumeration date
10/26/2010
Last updated
10/26/2010
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