MEDICARE: MR. BENJAMIN JOHN BRIGHTMAN OTRL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5333	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	136KY	OTHER	NC	BCBS NC

General Provider Information

NPI Number	:	1821293457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN JOHN BRIGHTMAN OTRL

Provider Business Mailing Address
First Line	:	PO BOX 7594
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-0594
Country	:	US
Telephone Number	:	252-443-9103
Fax Number	:	252-451-9032

Provider Business Practice Location Address
First Line	:	143 NASHVILLE COMMONS DR
Second Line	:
City	:	NASHVILLE
State	:	NC
Zip	:	27856-1823
Country	:	US
Telephone Number	:	252-459-5565
Fax Number	:	252-459-5568

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	08/03/2011

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