Healthcare Provider Details

I. General information

NPI: 1801545207
Provider Name (Legal Business Name): COASTAL KIDS OCCUPATIONAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 PORTLAND RD
ARUNDEL ME
04046-8104
US

IV. Provider business mailing address

8 WARRENS WAY
KENNEBUNK ME
04043-6115
US

V. Phone/Fax

Practice location:
  • Phone: 207-337-1058
  • Fax:
Mailing address:
  • Phone: 207-337-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PEPPER GALLAGHER
Title or Position: OWNER
Credential: OTR/L
Phone: 207-337-1058