MEDICARE: PACIFIC COAST THERAPY, INC.

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	235Z00000X	Speech-Language Pathologist	13140	CA

General Provider Information

NPI Number	:	1699927921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC COAST THERAPY, INC.

Provider Business Mailing Address
First Line	:	26761 CALLE MARIA
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-1527
Country	:	US
Telephone Number	:	949-463-3067
Fax Number	:

Provider Business Practice Location Address
First Line	:	26761 CALLE MARIA
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-1527
Country	:	US
Telephone Number	:	949-463-3067
Fax Number	:

Authorized Official
Title or Position	:	CEO/SPEECH-LANGUAGE PATHOLOGIST
Name	:	MURIEL NICOLE GODFREY
Credential	:	MS-CCC
Telephone Number	:	949-463-3067

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	10/17/2008

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