Provider Demographics
NPI:1821293457
Name:BRIGHTMAN, BENJAMIN JOHN (OTRL)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:JOHN
Last Name:BRIGHTMAN
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7594
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0594
Mailing Address - Country:US
Mailing Address - Phone:252-443-9103
Mailing Address - Fax:252-451-9032
Practice Address - Street 1:143 NASHVILLE COMMONS DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1823
Practice Address - Country:US
Practice Address - Phone:252-459-5565
Practice Address - Fax:252-459-5568
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5333225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301714Medicaid
NC136KYOtherBCBS NC
NC7301714Medicaid