MEDICARE: OCEAN STATE THERAPY AND WELLNESS. LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	ISW01777	RI

General Provider Information

NPI Number	:	1255802096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN STATE THERAPY AND WELLNESS. LLC

Provider Business Mailing Address
First Line	:	235 OLD FLAT RIVER RD
Second Line	:
City	:	COVENTRY
State	:	RI
Zip	:	02816-5149
Country	:	US
Telephone Number	:	401-374-2955
Fax Number	:	401-268-3887

Provider Business Practice Location Address
First Line	:	130 TOWER HILL RD
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4804
Country	:	US
Telephone Number	:	401-268-3886
Fax Number	:	401-268-3887

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KELLEY FINCH
Credential	:
Telephone Number	:	401-374-2955

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	12/05/2018

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