Provider Demographics
NPI:1801416565
Name:COOL BEANS THERAPY CLUBHOUSE, LLC
Entity Type:Organization
Organization Name:COOL BEANS THERAPY CLUBHOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CROME
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:704-237-4105
Mailing Address - Street 1:17111 KENTON DR STE 206B
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5650
Mailing Address - Country:US
Mailing Address - Phone:704-237-4105
Mailing Address - Fax:704-237-4107
Practice Address - Street 1:17111 KENTON DR STE 206B
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5650
Practice Address - Country:US
Practice Address - Phone:704-237-4105
Practice Address - Fax:704-237-4107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty