Provider Demographics
NPI:1922034420
Name:COASTAL HAND THERAPY INC
Entity Type:Organization
Organization Name:COASTAL HAND THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MHS OTR CHT
Authorized Official - Phone:843-521-9673
Mailing Address - Street 1:18 PROFESSIONAL VILLAGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907
Mailing Address - Country:US
Mailing Address - Phone:843-521-9673
Mailing Address - Fax:843-986-9369
Practice Address - Street 1:18 PROFESSIONAL VILLAGE CIRCLE
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907
Practice Address - Country:US
Practice Address - Phone:843-521-9673
Practice Address - Fax:843-986-9369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1092225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q31935Medicare UPIN
SC7554Medicare ID - Type UnspecifiedGROUP