Individual
JOHANNA ELAINE EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
159 W 1ST ST, OSWEGO, NY 13126-2045
(315) 342-9575
Mailing address
PO BOX 45, CENTRAL SQUARE, NY 13036-0045
(315) 440-7883
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
010218
NY
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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