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General NPI Number Information
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NPI Number | 1184156176
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Entity Type | Organization
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Legal Business Name | COASTAL NATURAL MEDICINE, LLC
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 559 FREEMAN AVE
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City | STRATFORD
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State | CT
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Zip | 06614-4031
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Country | US
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Telephone | 475-999-2032
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 POST RD SUITE L2
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City | SOUTHPORT
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State | CT
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Zip | 06890-1258
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Country | US
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Telephone | 475-999-2032
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Fax |
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Authorized Official
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Title or Position | NATUROPATHIC DOCTOR/OWNER
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Name | DR. KATHRYN MARY FIRISIN
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Credential | N.D.
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Telephone | 475-999-2032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 595
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License Number State | CT
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