Provider Demographics
NPI:1720328388
Name:GULF COAST OCCUPATIONAL THERAPY LLC
Entity type:Organization
Organization Name:GULF COAST OCCUPATIONAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BONOMO
Authorized Official - Suffix:
Authorized Official - Credentials:MS/SLP/CCC
Authorized Official - Phone:409-242-6500
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77553-0057
Mailing Address - Country:US
Mailing Address - Phone:409-242-6500
Mailing Address - Fax:409-497-4389
Practice Address - Street 1:928 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550
Practice Address - Country:US
Practice Address - Phone:409-242-6500
Practice Address - Fax:409-497-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty