Healthcare Provider Details

I. General information

NPI: 1033003421
Provider Name (Legal Business Name): FUTRELL COASTAL ROOTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WHITE HERON COVE RD
HAMPSTEAD NC
28443-8485
US

IV. Provider business mailing address

119 WHITE HERON COVE RD
HAMPSTEAD NC
28443-8485
US

V. Phone/Fax

Practice location:
  • Phone: 910-290-1534
  • Fax:
Mailing address:
  • Phone: 910-239-8599
  • Fax: 910-239-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAURA FUTRELL
Title or Position: OWNER
Credential:
Phone: 910-239-8599