MEDICARE: EVELYNS ANGELS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171400000X	Health & Wellness Coach
2	172V00000X	Community Health Worker
3	174H00000X	Health Educator
4	222Q00000X	Developmental Therapist
5	224Y00000X	Clinical Exercise Physiologist
6	225400000X	Rehabilitation Practitioner
7	225800000X	Recreation Therapist
8	225X00000X	Occupational Therapist
9	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1629635370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVELYNS ANGELS

Provider Business Mailing Address
First Line	:	1317 POST OAK PARK DR APT 542
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-2111
Country	:	US
Telephone Number	:	713-429-0856
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 POST OAK PARK DR APT 542
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-2111
Country	:	US
Telephone Number	:	713-429-0856
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. KENYA M WILLIAMSON
Credential	:	COTA/L
Telephone Number	:	937-520-1346

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	03/21/2022

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