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General NPI Number Information
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NPI Number | 1851906085
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Entity Type | Organization
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Legal Business Name | EVOLVING HOMES
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 1361 13TH AVE S STE 160
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3235
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Country | US
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Telephone | 904-400-3754
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Fax |
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Provider Business Mailing Address
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Address Line | 1451 LINKSIDE DR
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233
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Country | US
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Telephone | 904-400-3754
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAROL CHIANG
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Credential | OTR/L
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Telephone | 904-400-3754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XE0001X
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Taxonomy Name | Environmental Modification Occupational Therapist
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License Number |
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License Number State |
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