Provider Demographics
NPI:1821467499
Name:COASTAL OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:COASTAL OCCUPATIONAL THERAPY
Other - Org Name:COASTAL THERAPY PARTNERS
Other - Org Type:Other Name
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:MAREE
Authorized Official - Last Name:COE-THOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:910-679-8385
Mailing Address - Street 1:6770 PARKER FARM DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3175
Mailing Address - Country:US
Mailing Address - Phone:910-679-8385
Mailing Address - Fax:910-679-8387
Practice Address - Street 1:6770 PARKER FARM DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3175
Practice Address - Country:US
Practice Address - Phone:910-679-8385
Practice Address - Fax:910-679-8387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL THERAPY PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225X00000X252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherEIN