Provider Demographics
NPI:1023055415
Name:COAST HAND THERAPY, INC.
Entity type:Organization
Organization Name:COAST HAND THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:III
Authorized Official - Credentials:OTR/L-CHT
Authorized Official - Phone:228-575-4654
Mailing Address - Street 1:1105 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2654
Mailing Address - Country:US
Mailing Address - Phone:228-575-4654
Mailing Address - Fax:228-575-4651
Practice Address - Street 1:1105 39TH AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2654
Practice Address - Country:US
Practice Address - Phone:228-575-4654
Practice Address - Fax:228-575-4651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0116225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09382312Medicaid
MS09382312Medicaid
MSC03474Medicare PIN