Organization
BRAIN WAVES INC.
Active
Organization
BRAIN WAVES INC.
Active
Other names
Brain Waves
Organization subpart
No
Provider details
NPI number
Authorized official
ELLERY JAIMES LOCKWOOD OTR/L (CEO)
(805) 888-0842
Entity
Organization
Contact information
Practice address
245 SANTA FE AVE, PISMO BEACH, CA 93449-1948
(805) 888-0842
Mailing address
245 SANTA FE AVE, PISMO BEACH, CA 93449-1948
(805) 888-0842
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Enumeration date
09/03/2024
Last updated
09/03/2024
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