Bright Spark Therapy
Speech-Language Pathologist, in Orange Park, FL. Organization (NPI-2).
NPI number1104567494
StatusActive
Last updated in NPPESMay 25, 2022
Details
- NPI
- 1104567494
- Entity type
- Organization (NPI-2)
- Legal business name
- Bright Spark Therapy
- Organization subpart
- No
- Enumeration date
- Apr 2, 2022
- Certification date
- May 25, 2022
- Last updated
- May 25, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 235Z00000X | Speech-Language Pathologist, | – | – | Yes |
| 2251P0200X | Physical Therapist, Pediatrics | – | – | |
| 225X00000X | Occupational Therapist | – | – |
Practice location
3837 Cardinal Oaks CirOrange Park, FL 32065-4251
Phone 904-601-2079
Mailing address
3837 Cardinal Oaks CirOrange Park, FL 32065-4251
Authorized official
Sara Werner
Speech Language Pathologist
9046012079
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