Individual
EVAN JAY DETWEILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBA, OT
Contact information
Practice address
611 W COUNTY LINE RD S, FORT WAYNE, IN 46814-7592
(260) 625-1445
(260) 625-1445
Mailing address
2222 SULLIVAN TRL, EASTON, PA 18040-7958
(800) 944-9782
(610) 438-2046
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31002343A
IN
Other
Enumeration date
01/14/2013
Last updated
01/14/2013
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