Individual
EVAN LINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
1611 W HARRISON ST STE 107, CHICAGO, IL 60612-4861
(877) 632-6637
Mailing address
1611 W HARRISON ST STE 107, CHICAGO, IL 60612-4861
(877) 632-6637
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056013025
IL
225X00000X
Occupational Therapist
31006516A
IN
Other
Enumeration date
02/02/2018
Last updated
09/12/2023
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