Basic Information
| Provider Information | |||||||||
| NPI: | 1811577869 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | CHRISTA | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2192 | ||||||||
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| City: | FORREST CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723362192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706331737 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3998 HIGHWAY 1 N | ||||||||
| Address2: | |||||||||
| City: | FORREST CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723357637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706331737 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2021 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OT-A1649 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.