Provider Demographics
NPI:1417280892
Name:BRIGHTER FUTURES THERAPEUTIC LEARNING CENTER
Entity Type:Organization
Organization Name:BRIGHTER FUTURES THERAPEUTIC LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:209-574-9707
Mailing Address - Street 1:PO BOX 1396
Mailing Address - Street 2:
Mailing Address - City:EMPIRE
Mailing Address - State:CA
Mailing Address - Zip Code:95319-1396
Mailing Address - Country:US
Mailing Address - Phone:209-574-9707
Mailing Address - Fax:209-574-9587
Practice Address - Street 1:4715 YOSEMITE BOULEVARD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95357
Practice Address - Country:US
Practice Address - Phone:209-574-9707
Practice Address - Fax:209-574-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 5534225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty