Organization
BRAIN FIX SPECIALIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY A CARLSO IMC (OWNER)
(719) 289-1191
Entity
Organization
Contact information
Practice address
503 N MAIN ST STE 657, PUEBLO, CO 81003-3132
(719) 289-1191
Mailing address
503 N MAIN ST STE 657, PUEBLO, CO 81003-3132
(719) 289-1191
Taxonomy
Speciality
Code
Description
License number
State
224ZE0001X
Environmental Modification Occupational Therapy Assistant
Primary
—
CO
225XN1300X
Neurorehabilitation Occupational Therapist
—
CO
Other
Enumeration date
09/04/2013
Last updated
09/04/2013
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