Organization
EXPLORE ENGAGE ENJOY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA IRENE MOYER MOTR/L (EXECUTIVE DIRECTORY)
(541) 680-6360
Entity
Organization
Contact information
Practice address
2198 NE STEPHENS ST STE 101, ROSEBURG, OR 97470-1410
(541) 900-1418
(541) 900-1419
Mailing address
2198 NE STEPHENS ST STE 101, ROSEBURG, OR 97470-1410
(541) 900-1418
(541) 900-1419
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134568629
—
OR
Enumeration date
03/01/2023
Last updated
03/01/2023
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