Provider Demographics
NPI:1194214692
Name:BRAINS IN MOTION, LLC.
Entity Type:Organization
Organization Name:BRAINS IN MOTION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OT/L
Authorized Official - Phone:217-891-1524
Mailing Address - Street 1:4405 LYNHURST RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7131
Mailing Address - Country:US
Mailing Address - Phone:217-891-1524
Mailing Address - Fax:
Practice Address - Street 1:3050 MONTVALE DR SUITE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-9415
Practice Address - Country:US
Practice Address - Phone:217-891-1524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008995225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty