Provider Demographics
NPI:1366984882
Name:EVANS, QUINTON DJ (MSOT OTR/L)
Entity type:Individual
Prefix:
First Name:QUINTON
Middle Name:DJ
Last Name:EVANS
Suffix:
Gender:M
Credentials:MSOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9110 CRANBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1321
Mailing Address - Country:US
Mailing Address - Phone:330-348-7238
Mailing Address - Fax:
Practice Address - Street 1:9110 CRANBROOK DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-1321
Practice Address - Country:US
Practice Address - Phone:330-348-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2021-10-29
Deactivation Date:2021-10-19
Deactivation Code:
Reactivation Date:2021-10-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program