Healthcare Provider Details

I. General information

NPI: 1417280892
Provider Name (Legal Business Name): BRIGHTER FUTURES THERAPEUTIC LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 YOSEMITE BOULEVARD
MODESTO CA
95357
US

IV. Provider business mailing address

PO BOX 1396
EMPIRE CA
95319-1396
US

V. Phone/Fax

Practice location:
  • Phone: 209-574-9707
  • Fax: 209-574-9587
Mailing address:
  • Phone: 209-574-9707
  • Fax: 209-574-9587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 5534
License Number StateCA

VIII. Authorized Official

Name: LUCINDA LEANN ANDERSON
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 209-574-9707