Provider Demographics
NPI:1992117931
Name:BRIGHTER DAY THERAPLAY HOUSE
Entity type:Organization
Organization Name:BRIGHTER DAY THERAPLAY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAHZARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRA
Authorized Official - Suffix:
Authorized Official - Credentials:MOT/L, ARR
Authorized Official - Phone:704-248-1474
Mailing Address - Street 1:9611 BROOKDALE DR
Mailing Address - Street 2:#100-126
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8719
Mailing Address - Country:US
Mailing Address - Phone:704-983-5437
Mailing Address - Fax:704-983-0144
Practice Address - Street 1:333 PEE DEE AVE
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4931
Practice Address - Country:US
Practice Address - Phone:704-248-1474
Practice Address - Fax:704-983-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2251P0200X, 225XP0200X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty