Provider Demographics
NPI:1063853158
Name:OUTER PLANETARY TOUCH
Entity Type:Organization
Organization Name:OUTER PLANETARY TOUCH
Other - Org Name:BRIGHTER DAY THERAPLAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAHZARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRA
Authorized Official - Suffix:
Authorized Official - Credentials:MOT/L
Authorized Official - Phone:704-248-1474
Mailing Address - Street 1:9611 BROOKDALE DR
Mailing Address - Street 2:100-126
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8719
Mailing Address - Country:US
Mailing Address - Phone:704-248-1474
Mailing Address - Fax:
Practice Address - Street 1:333 PEE DEE AVE
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4931
Practice Address - Country:US
Practice Address - Phone:704-248-1474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTER DAY THERAPLAY HOUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-17
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP97592251P0200X
NC4329225XP0200X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1063853158Medicaid