Provider Demographics
NPI:1598504797
Name:BLUE SEA THERAPY, LLC
Entity type:Organization
Organization Name:BLUE SEA THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:SOPHIA
Authorized Official - Last Name:ST. AMAND
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:508-887-2747
Mailing Address - Street 1:62 EMERALD RD
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-1536
Mailing Address - Country:US
Mailing Address - Phone:413-537-3407
Mailing Address - Fax:
Practice Address - Street 1:62 EMERALD RD
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:MA
Practice Address - Zip Code:01543-1536
Practice Address - Country:US
Practice Address - Phone:413-537-3407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty