Individual
STACI EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2927 SE VILLAGE LOOP, VANCOUVER, WA 98683-8119
(360) 253-3855
Mailing address
8015 SE COTTRELL RD, BORING, OR 97009-6806
(757) 870-1171
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
970127
OR
Other
Enumeration date
03/25/2015
Last updated
03/25/2015
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