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General NPI Number Information
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NPI Number | 1346823747
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Entity Type | Organization
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Legal Business Name | THE MOBILE BRAIN, LLC
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 10/08/2022
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Provider Practice Location Address
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Address Line | 11140 ROCKVILLE PIKE STE 100-1206
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City | ROCKVILLE
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State | MD
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Zip | 20852-3106
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Country | US
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Telephone | 240-839-1454
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Fax | 240-399-1354
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Provider Business Mailing Address
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Address Line | 11140 ROCKVILLE PIKE STE 100-1206
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City | ROCKVILLE
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State | MD
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Zip | 20852-3106
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Country | US
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Telephone | 240-839-1454
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Fax | 240-399-1354
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KATHERINE GRACE C REYES
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Credential | OTD, OTR/L, CSRS
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Telephone | 240-839-1390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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