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General NPI Number Information
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NPI Number | 1972862761
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Entity Type | Organization
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Legal Business Name | CONNECTIONS ACHIEVEMENT AND THERAPY CENTER, CORP
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 6746 THIRLANE RD
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City | ROANOKE
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State | VA
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Zip | 24019-2908
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Country | US
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Telephone | 540-400-8505
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Fax | 540-566-3924
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Provider Business Mailing Address
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Address Line | 6746 THIRLANE RD
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City | ROANOKE
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State | VA
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Zip | 24019-2908
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Country | US
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Telephone | 540-400-8505
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Fax | 540-566-3924
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | DR. BRICE JACKSON
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Credential | DC FACFN FABBIR
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Telephone | 540-400-8505
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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 | 0119004835
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License Number State | VA
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