Healthcare Provider Details

I. General information

NPI: 1710817184
Provider Name (Legal Business Name): CHANGING TIDES THERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E PIONEER AVE STE 203
HOMER AK
99603-7694
US

IV. Provider business mailing address

601 E PIONEER AVE STE 203
HOMER AK
99603-7694
US

V. Phone/Fax

Practice location:
  • Phone: 907-435-1071
  • Fax:
Mailing address:
  • Phone: 907-435-1071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JILL ZANK
Title or Position: PRESIDENT, DIRECTOR
Credential: MS, CCC-SLP
Phone: 907-399-8400