Provider Demographics
NPI:1558783415
Name:BRIGHTER SKIES THERAPY
Entity Type:Organization
Organization Name:BRIGHTER SKIES THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANNERY
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR/L
Authorized Official - Phone:601-259-8517
Mailing Address - Street 1:6208 FERNCREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2003
Mailing Address - Country:US
Mailing Address - Phone:601-259-8517
Mailing Address - Fax:
Practice Address - Street 1:5760 I 55 N STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2651
Practice Address - Country:US
Practice Address - Phone:601-259-8517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1714225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00835524Medicaid