Healthcare Provider Details

I. General information

NPI: 1164957890
Provider Name (Legal Business Name): BRAIN BRIGHT THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5164 MONROE ST
TOLEDO OH
43623-3471
US

IV. Provider business mailing address

5164 MONROE ST
TOLEDO OH
43623-3471
US

V. Phone/Fax

Practice location:
  • Phone: 419-279-9576
  • Fax: 419-214-1233
Mailing address:
  • Phone: 419-279-9576
  • Fax: 419-214-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE LYNN NELSON
Title or Position: OWNER
Credential: OTR/L
Phone: 419-410-4341