Provider Demographics
NPI:1093180986
Name:SEACOAST PLAY WORKS THERAPY, PLLC
Entity Type:Organization
Organization Name:SEACOAST PLAY WORKS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:978-799-2580
Mailing Address - Street 1:15 BALSAM LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4434
Mailing Address - Country:US
Mailing Address - Phone:978-799-2580
Mailing Address - Fax:603-658-5435
Practice Address - Street 1:15 BALSAM LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NH
Practice Address - Zip Code:03833-4434
Practice Address - Country:US
Practice Address - Phone:978-799-2580
Practice Address - Fax:603-658-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2374225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty