Provider Demographics
NPI:1639904477
Name:BRAIN WAVES INC.
Entity type:Organization
Organization Name:BRAIN WAVES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELLERY
Authorized Official - Middle Name:JAIMES
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:805-888-0842
Mailing Address - Street 1:245 SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-1948
Mailing Address - Country:US
Mailing Address - Phone:805-888-0842
Mailing Address - Fax:
Practice Address - Street 1:245 SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-1948
Practice Address - Country:US
Practice Address - Phone:805-888-0842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty