Provider Demographics
NPI:1881388999
Name:PHILLYCARE COACHING LLC
Entity type:Organization
Organization Name:PHILLYCARE COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:267-375-9131
Mailing Address - Street 1:21 ASHMEAD PL N
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2916
Mailing Address - Country:US
Mailing Address - Phone:267-375-9131
Mailing Address - Fax:267-787-1142
Practice Address - Street 1:21 ASHMEAD PL N
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2916
Practice Address - Country:US
Practice Address - Phone:267-375-9131
Practice Address - Fax:267-787-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty