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General NPI Number Information
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NPI Number | 1235447921
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Entity Type | Organization
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Legal Business Name | CROSBY COASTAL THERAPY, LLC
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 115 COLLETON AVE
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City | SUMMERVILLE
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State | SC
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Zip | 29483-4313
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Country | US
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Telephone | 843-452-9467
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Fax |
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Provider Business Mailing Address
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Address Line | 115 COLLETON AVE
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City | SUMMERVILLE
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State | SC
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Zip | 29483-4313
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Country | US
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Telephone | 843-452-9467
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPSIT/OWNER
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Name | AMY M CROSBY
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Credential | MSR, OTR/L
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Telephone | 843-452-9467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 2763
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License Number State | SC
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