Provider Demographics
NPI:1902030471
Name:EVOLUTION THERAPY
Entity Type:Organization
Organization Name:EVOLUTION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD OT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPAETH-HARRER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:651-247-2126
Mailing Address - Street 1:2508 EDINBROOK TER
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3739
Mailing Address - Country:US
Mailing Address - Phone:651-247-2126
Mailing Address - Fax:
Practice Address - Street 1:2508 EDINBROOK TER
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3739
Practice Address - Country:US
Practice Address - Phone:651-247-2126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101184261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities