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General NPI Number Information
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NPI Number | 1598219164
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Entity Type | Organization
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Legal Business Name | BRAIN AND BODY CONNECTIONS, LLC
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 420 THOMASTON ST
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City | ZEBULON
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State | GA
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Zip | 30295-3387
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Country | US
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Telephone | 678-572-9430
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Fax | 678-550-9047
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Provider Business Mailing Address
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Address Line | PO BOX 1264
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City | ZEBULON
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State | GA
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Zip | 30295-1264
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Country | US
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Telephone | 678-572-9430
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Fax | 678-550-9047
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Authorized Official
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Title or Position | BILLING AGENT
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Name | NICOLE KNIGHT
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Credential |
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Telephone | 478-987-3154
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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 | OT000502
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License Number State | GA
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