Healthcare Provider Details

I. General information

NPI: 1902462450
Provider Name (Legal Business Name): ADVANCED COASTAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 PLANTATION HOUSE DR
BLUFFTON SC
29910-4774
US

IV. Provider business mailing address

71 PLANTATION HOUSE DR
BLUFFTON SC
29910-4774
US

V. Phone/Fax

Practice location:
  • Phone: 843-321-8341
  • Fax: 843-706-9050
Mailing address:
  • Phone: 843-321-8341
  • Fax: 843-706-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: NATALIE BASINGER
Title or Position: OT
Credential:
Phone: 843-321-8341