Individual
EVELYN LOURIDO ISHLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1400 FORDHAM DR, VIRGINIA BEACH, VA 23464-5368
(757) 361-3954
Mailing address
1463 REYNARD CRES, APT D, VIRGINIA BEACH, VA 23451-6025
(607) 621-3645
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
010968-1
NY
225XP0200X
Pediatric Occupational Therapist
Primary
0119006676
VA
Other
Enumeration date
08/31/2011
Last updated
07/31/2015
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