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General NPI Number Information
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NPI Number | 1093180986
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Entity Type | Organization
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Legal Business Name | SEACOAST PLAY WORKS THERAPY, PLLC
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 15 BALSAM LN
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City | BRENTWOOD
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State | NH
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Zip | 03833-4434
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Country | US
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Telephone | 978-799-2580
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Fax | 603-658-5435
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Provider Business Mailing Address
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Address Line | 15 BALSAM LN
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City | BRENTWOOD
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State | NH
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Zip | 03833-4434
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Country | US
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Telephone | 978-799-2580
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Fax | 603-658-5435
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Authorized Official
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Title or Position | OWNER
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Name | KRISTEN M GOODRICH
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Credential | OTR
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Telephone | 978-799-2580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 2374
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License Number State | NH
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