Provider Demographics
NPI:1669732079
Name:COASTAL KIDS THERAPY PLLC
Entity type:Organization
Organization Name:COASTAL KIDS THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:910-977-0658
Mailing Address - Street 1:219 RACINE DR
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8827
Mailing Address - Country:US
Mailing Address - Phone:910-792-6706
Mailing Address - Fax:910-792-6737
Practice Address - Street 1:219 RACINE DR
Practice Address - Street 2:SUITE 1-A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8827
Practice Address - Country:US
Practice Address - Phone:910-792-6706
Practice Address - Fax:910-792-6737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty