MEDICARE: EVOLVING HOMES

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	225XE0001X	Environmental Modification Occupational Therapist

General Provider Information

NPI Number	:	1851906085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVING HOMES

Provider Business Mailing Address
First Line	:	1451 LINKSIDE DR
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233
Country	:	US
Telephone Number	:	904-400-3754
Fax Number	:

Provider Business Practice Location Address
First Line	:	1361 13TH AVE S STE 160
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3235
Country	:	US
Telephone Number	:	904-400-3754
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAROL CHIANG
Credential	:	OTR/L
Telephone Number	:	904-400-3754

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	02/17/2021

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Directions to “EVOLVING HOMES ” Practice Location

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