Basic Information
| Provider Information | |||||||||
| NPI: | 1821293457 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRIGHTMAN | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OTRL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7594 | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278040594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524439103 | ||||||||
| FaxNumber: | 2524519032 | ||||||||
| Practice Location | |||||||||
| Address1: | 143 NASHVILLE COMMONS DR | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278561823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524595565 | ||||||||
| FaxNumber: | 2524595568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 08/03/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5333 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7301714 | 05 | NC | MEDICAID | 136KY | 01 | NC | BCBS NC | OTHER |