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General NPI Number Information
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NPI Number | 1942835418
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Entity Type | Organization
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Legal Business Name | HEAL THE BRAIN WITH JANE
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Dates
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Enumeration Date | 03/05/2020
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 47 SANTA ROSA ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1811
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Country | US
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Telephone | 949-433-8457
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Fax |
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Provider Business Mailing Address
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Address Line | 475 POA PL
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-4768
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Country | US
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Telephone | 949-433-8457
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Fax |
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Authorized Official
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Title or Position | FOUNDER/ OCCUPATIONAL THERAPIST
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Name | JANE DESMOND CONNELY
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Credential | OTR/L
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Telephone | 949-433-8457
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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 |
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License Number State |
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