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General NPI Number Information
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NPI Number | 1568851368
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Entity Type | Organization
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Legal Business Name | BRAIN FIT ACADEMY, INC
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Dates
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Enumeration Date | 01/16/2015
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Last Update Date | 01/16/2015
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Provider Practice Location Address
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Address Line | 25 WESTCOTT RD
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City | HOPEDALE
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State | MA
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Zip | 01747-1824
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Country | US
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Telephone | 508-478-1031
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Fax |
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Provider Business Mailing Address
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Address Line | 25 WESTCOTT RD
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City | HOPEDALE
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State | MA
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Zip | 01747-1824
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Country | US
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Telephone | 508-478-1031
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. PAMELA MARIE FORMOSA
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Credential | OTR/L
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Telephone | 508-478-5164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 2461
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License Number State | MA
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