Provider Demographics
NPI:1568882678
Name:COAST ALLIED HEALTH
Entity Type:Organization
Organization Name:COAST ALLIED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLIE
Authorized Official - Middle Name:CHAINANI
Authorized Official - Last Name:BIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:805-996-0899
Mailing Address - Street 1:805 AEROVISTA PL STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7921
Mailing Address - Country:US
Mailing Address - Phone:805-996-0899
Mailing Address - Fax:805-250-3089
Practice Address - Street 1:805 AEROVISTA PL STE 101
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7921
Practice Address - Country:US
Practice Address - Phone:805-996-0899
Practice Address - Fax:805-250-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT8048225X00000X, 225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT8048OtherOTHER