Basic Information
| Provider Information | |||||||||
| NPI: | 1972847424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVASSEUR | ||||||||
| FirstName: | EVELYN | ||||||||
| MiddleName: | MIRANDA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22144 MAMARONECK AVE | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339526925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414886733 | ||||||||
| FaxNumber: | 9414845610 | ||||||||
| Practice Location | |||||||||
| Address1: | 1240 PINEBROOK RD | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342856421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414886733 | ||||||||
| FaxNumber: | 9414845610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2012 | ||||||||
| LastUpdateDate: | 11/22/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0019X | OT2027 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No ID Information.