Provider Demographics
NPI:1134609894
Name:EVANGELISTA, LUCIA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:EVANGELISTA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 CLEARVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1848
Mailing Address - Country:US
Mailing Address - Phone:215-868-6619
Mailing Address - Fax:
Practice Address - Street 1:7020 CLEARVIEW ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1848
Practice Address - Country:US
Practice Address - Phone:215-868-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12813225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist