=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821873456
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAINWAVES PEDIATRIC THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2023
-----------------------------------------------------
Last Update Date | 08/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24486 WHISPERING PINES CIR
-----------------------------------------------------
City | MENIFEE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92584-0314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-454-8115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24486 WHISPERING PINES CIR
-----------------------------------------------------
City | MENIFEE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92584-0314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST/CEO
-----------------------------------------------------
Name | DR. ERIN MONISE
-----------------------------------------------------
Credential | OTD, OTR/L
-----------------------------------------------------
Telephone | 951-454-8115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------