Provider Demographics
NPI:1417281551
Name:M63 INC.
Entity Type:Organization
Organization Name:M63 INC.
Other - Org Name:BRAINASIUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-780-1818
Mailing Address - Street 1:9085 AUBURN FOLSOM RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-9656
Mailing Address - Country:US
Mailing Address - Phone:916-780-1818
Mailing Address - Fax:916-780-2112
Practice Address - Street 1:9085 AUBURN FOLSOM RD
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-9656
Practice Address - Country:US
Practice Address - Phone:916-780-1818
Practice Address - Fax:916-780-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty