Organization
BEACH PEDIATRIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH ELIZABETH GLEASON COTA/L (OWNER)
(814) 598-8434
Entity
Organization
Contact information
Practice address
405 BEAR TREE CT, MONCKS CORNER, SC 29461-7475
(814) 598-8434
Mailing address
405 BEAR TREE CT, MONCKS CORNER, SC 29461-7475
(814) 598-8434
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5855964011
—
NY
Enumeration date
09/06/2024
Last updated
09/06/2024
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