Provider Demographics
NPI:1972862761
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/CLINICAL DIRECTOR
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 FACFN FABBIR
Authorized Official - Phone:540-400-8505
Mailing Address - Street 1:6746 THIRLANE RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-2908
Mailing Address - Country:US
Mailing Address - Phone:540-400-8505
Mailing Address - Fax:540-566-3924
Practice Address - Street 1:6746 THIRLANE RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-2908
Practice Address - Country:US
Practice Address - Phone:540-400-8505
Practice Address - Fax:540-566-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004835225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty