Healthcare Provider Details

I. General information

NPI: 1104720234
Provider Name (Legal Business Name): COASTLINE THERAPY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 WRIGHTSVILLE AVE STE 120
WILMINGTON NC
28403-6256
US

IV. Provider business mailing address

4936 PLEASANT GROVE DR
WILMINGTON NC
28412-2288
US

V. Phone/Fax

Practice location:
  • Phone: 910-679-8385
  • Fax: 910-679-8387
Mailing address:
  • Phone: 252-299-6703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MADISON PYLE
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTD, OTR/L, B.S.
Phone: 252-299-6703