Provider Demographics
NPI:1376620518
Name:BRIGHTER DAY THERAPLAY LLC
Entity Type:Organization
Organization Name:BRIGHTER DAY THERAPLAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAHZARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, OTR/L
Authorized Official - Phone:704-248-1474
Mailing Address - Street 1:7209 E WT HARRIS BLVD STE J
Mailing Address - Street 2:#134
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-1004
Mailing Address - Country:US
Mailing Address - Phone:704-452-0245
Mailing Address - Fax:704-561-0850
Practice Address - Street 1:7950 NATIONS FORD RD
Practice Address - Street 2:SUITE B4
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-8014
Practice Address - Country:US
Practice Address - Phone:704-452-0245
Practice Address - Fax:704-561-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97592251P0200X
NC4329225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212077Medicaid