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General NPI Number Information
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NPI Number | 1811669344
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Entity Type | Organization
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Legal Business Name | EVOLVED LIVING THERAPY PLLC
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 1205 S STEVENS ST
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City | TACOMA
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State | WA
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Zip | 98405-1125
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Country | US
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Telephone | 425-405-0849
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 S STEVENS ST
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City | TACOMA
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State | WA
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Zip | 98405-1125
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST OWNER
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Name | JOSEPHINE JARVIS MA
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Credential |
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Telephone | 425-405-0849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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