Basic Information
| Provider Information | |||||||||
| NPI: | 1124330741 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTAL THERAPY SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 LAFAYETTE RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | NORTH HAMPTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038622451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036012752 | ||||||||
| FaxNumber: | 6036012752 | ||||||||
| Practice Location | |||||||||
| Address1: | 989 OCEAN BLVD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | HAMPTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038421453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036012752 | ||||||||
| FaxNumber: | 6036012752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2010 | ||||||||
| LastUpdateDate: | 07/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | EARWOOD | ||||||||
| AuthorizedOfficialFirstName: | KENDRA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6036012752 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S., CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.