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General NPI Number Information
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NPI Number | 1558783415
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Entity Type | Organization
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Legal Business Name | BRIGHTER SKIES THERAPY
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 5760 I 55 N STE 300
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City | JACKSON
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State | MS
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Zip | 39211-2651
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Country | US
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Telephone | 601-259-8517
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Fax |
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Provider Business Mailing Address
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Address Line | 6208 FERNCREEK DR
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City | JACKSON
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State | MS
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Zip | 39211-2003
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Country | US
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Telephone | 601-259-8517
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/OWNER
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Name | TARAH A MANNERY
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Credential | MSOTR/L
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Telephone | 601-259-8517
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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 | OT1714
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License Number State | MS
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