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General NPI Number Information
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NPI Number | 1912888702
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Entity Type | Organization
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Legal Business Name | BRAVE YOGA FOR ALL LLC
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 299 CLARK ROAD EXT
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City | FISKDALE
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State | MA
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Zip | 01518-1036
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Country | US
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Telephone | 508-330-1141
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Fax |
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Provider Business Mailing Address
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Address Line | 299 CLARK ROAD EXT
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City | FISKDALE
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State | MA
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Zip | 01518-1036
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Country | US
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Telephone |
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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 | LISA M IRVINE
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Credential | MS,OTR/L
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Telephone | 508-330-1141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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