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General NPI Number Information
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NPI Number | 1669004362
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Entity Type | Organization
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Legal Business Name | COASTAL OCCUPATIONAL THERAPY, LLC
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 870 N MIRAMAR AVE # 241
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City | INDIALANTIC
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State | FL
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Zip | 32903-3054
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Country | US
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Telephone | 321-361-8040
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Fax |
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Provider Business Mailing Address
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Address Line | 870 N MIRAMAR AVE # 241
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City | INDIALANTIC
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State | FL
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Zip | 32903-3054
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Country | US
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Telephone | 201-779-6392
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | JITAL PATEL
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Credential | OTR/L, BCTS
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Telephone | 321-361-8040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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