Provider Demographics
NPI:1770244774
Name:A PEDIATRIC EVOLUTION, LLC.
Entity Type:Organization
Organization Name:A PEDIATRIC EVOLUTION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OTR/L
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLINGHAST
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:401-489-4001
Mailing Address - Street 1:1445 WAMPANOAG TRL STE 108A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1000
Mailing Address - Country:US
Mailing Address - Phone:401-489-4001
Mailing Address - Fax:
Practice Address - Street 1:1445 WAMPANOAG TRL STE 108A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1000
Practice Address - Country:US
Practice Address - Phone:401-642-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty