Provider Demographics
NPI:1275995631
Name:SEA STARS THERAPY
Entity Type:Organization
Organization Name:SEA STARS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GUARIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-209-7174
Mailing Address - Street 1:1000 JOHNNIE DODDS BLVD
Mailing Address - Street 2:STE 103-179
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3135
Mailing Address - Country:US
Mailing Address - Phone:203-209-7174
Mailing Address - Fax:843-556-6742
Practice Address - Street 1:1000 JOHNNIE DODDS BLVD
Practice Address - Street 2:STE 103-179
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3135
Practice Address - Country:US
Practice Address - Phone:203-209-7174
Practice Address - Fax:843-556-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4188225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH2677Medicaid
4188OtherLICENSE