Provider Demographics
NPI:1518268630
Name:CONNECTIONS ACHIEVEMENT AND THERAPY CENTER, CORP
Entity Type:Organization
Organization Name:CONNECTIONS ACHIEVEMENT AND THERAPY CENTER, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-823-2199
Mailing Address - Street 1:375 FOUR LEAF LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-6905
Mailing Address - Country:US
Mailing Address - Phone:434-823-2199
Mailing Address - Fax:434-823-7099
Practice Address - Street 1:375 FOUR LEAF LN
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-6905
Practice Address - Country:US
Practice Address - Phone:434-823-2199
Practice Address - Fax:434-823-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty