Organization
BRIGHT SPOT PEDIATRIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN MOSKAL (OWNER)
(503) 850-8154
Entity
Organization
Contact information
Practice address
1425 N KILLINGSWORTH ST, PORTLAND, OR 97217-4541
(503) 575-9402
(888) 769-4431
Mailing address
1425 N KILLINGSWORTH ST, PORTLAND, OR 97217-4541
(503) 850-8154
(844) 234-8735
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
1042968
OR
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500796699
—
OR
Enumeration date
06/15/2017
Last updated
01/03/2022
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