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General NPI Number Information
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NPI Number | 1518268630
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Entity Type | Organization
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Legal Business Name | CONNECTIONS ACHIEVEMENT AND THERAPY CENTER, CORP
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 11/04/2010
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Provider Practice Location Address
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Address Line | 375 FOUR LEAF LN SUITE 202
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-6905
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Country | US
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Telephone | 434-823-2199
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Fax | 434-823-7099
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Provider Business Mailing Address
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Address Line | 375 FOUR LEAF LN SUITE 202
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-6905
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Country | US
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Telephone | 434-823-2199
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Fax | 434-823-7099
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. BRICE JACKSON
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Credential | DC
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Telephone | 434-823-2199
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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 | 0119002325
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License Number State | VA
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