MEDICARE: LUCIA EVANGELISTA MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OC018337	PA

General Provider Information

NPI Number	:	1134609894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIA EVANGELISTA MS, OTR/L

Provider Business Mailing Address
First Line	:	3300 HENRY AVE STE 100
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1146
Country	:	US
Telephone Number	:	267-407-0034
Fax Number	:	267-933-2111

Provider Business Practice Location Address
First Line	:	3300 HENRY AVE STE 100
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1146
Country	:	US
Telephone Number	:	267-407-0034
Fax Number	:	267-933-2111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	05/20/2026

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