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General NPI Number Information
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NPI Number | 1194451443
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Entity Type | Organization
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Legal Business Name | COASTAL SUNSHINE AND REIGN
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 2441 N 9TH AVE STE B
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City | PENSACOLA
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State | FL
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Zip | 32503-3989
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Country | US
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Telephone | 850-284-2093
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Fax |
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Provider Business Mailing Address
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Address Line | 3487 SHORTLEAF CT
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City | CANTONMENT
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State | FL
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Zip | 32533-8449
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Country | US
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Telephone | 850-284-2093
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS EBONI LYONS
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Credential |
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Telephone | 850-284-2093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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