Provider Demographics
NPI:1669004362
Name:COASTAL OCCUPATIONAL THERAPY, LLC
Entity Type:Organization
Organization Name:COASTAL OCCUPATIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JITAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, BCTS
Authorized Official - Phone:321-361-8040
Mailing Address - Street 1:870 N MIRAMAR AVE # 241
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3054
Mailing Address - Country:US
Mailing Address - Phone:201-779-6392
Mailing Address - Fax:
Practice Address - Street 1:870 N MIRAMAR AVE # 241
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3054
Practice Address - Country:US
Practice Address - Phone:321-361-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty