Individual
EVAN T WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4601 HARTFORD ST, ABILENE, TX 79605-4603
(325) 793-3400
(325) 793-3587
Mailing address
4601 HARTFORD ST, ABILENE, TX 79605-4603
(325) 793-3400
(325) 793-3587
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
122210
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122210
COMMERCIAL
TX
05
—
122210
—
TX
Enumeration date
11/16/2021
Last updated
11/16/2021
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