Provider Demographics
NPI:1568851368
Name:BRAIN FIT ACADEMY, INC
Entity type:Organization
Organization Name:BRAIN FIT ACADEMY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FORMOSA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:508-478-5164
Mailing Address - Street 1:25 WESTCOTT RD
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01747-1824
Mailing Address - Country:US
Mailing Address - Phone:508-478-1031
Mailing Address - Fax:
Practice Address - Street 1:25 WESTCOTT RD
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:MA
Practice Address - Zip Code:01747-1824
Practice Address - Country:US
Practice Address - Phone:508-478-1031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2461261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty