Healthcare Provider Details

I. General information

NPI: 1225758691
Provider Name (Legal Business Name): BEP INTEGRATIVE WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 KENNY RD STE 100
COLUMBUS OH
43221-2415
US

IV. Provider business mailing address

6565 S SECTION LINE RD
DELAWARE OH
43015-7961
US

V. Phone/Fax

Practice location:
  • Phone: 614-769-7687
  • Fax:
Mailing address:
  • Phone: 614-286-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARCIA BOCKBRADER
Title or Position: OWNER
Credential: MD PHD
Phone: 614-286-0305