=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992971741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL SPEECH SERVICES,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2008
-----------------------------------------------------
Last Update Date | 07/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1246 CABLE CREEK RD
-----------------------------------------------------
City | ASHEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27205-2328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-953-2105
-----------------------------------------------------
Fax | 336-736-3907
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1246 CABLE CREEK RD
-----------------------------------------------------
City | ASHEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27205-2328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-953-2105
-----------------------------------------------------
Fax | 336-736-3907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. HOLLY WARRICK MCROY
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 336-736-3907
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 3283
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------