Provider Demographics
NPI:1942835418
Name:HEAL THE BRAIN WITH JANE
Entity Type:Organization
Organization Name:HEAL THE BRAIN WITH JANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:DESMOND
Authorized Official - Last Name:CONNELY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:949-433-8457
Mailing Address - Street 1:475 POA PL
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-4768
Mailing Address - Country:US
Mailing Address - Phone:949-433-8457
Mailing Address - Fax:
Practice Address - Street 1:47 SANTA ROSA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1811
Practice Address - Country:US
Practice Address - Phone:949-433-8457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty