Healthcare Provider Details

I. General information

NPI: 1710640388
Provider Name (Legal Business Name): EVOLVE EARLY INTERVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480H US 41 N STE 80
HENDERSON KY
42420-2359
US

IV. Provider business mailing address

4101 RODENBERG AVE
EVANSVILLE IN
47720-6230
US

V. Phone/Fax

Practice location:
  • Phone: 812-228-6896
  • Fax: 270-212-0271
Mailing address:
  • Phone: 812-228-6896
  • Fax: 270-212-0271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KASIE BALLARD
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: MS, OTR/L
Phone: 812-228-6896