Provider Demographics
NPI:1073212924
Name:EXPLORE ENGAGE ENJOY
Entity Type:Organization
Organization Name:EXPLORE ENGAGE ENJOY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTORY
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L
Authorized Official - Phone:541-680-6360
Mailing Address - Street 1:2198 NE STEPHENS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1410
Mailing Address - Country:US
Mailing Address - Phone:541-900-1418
Mailing Address - Fax:541-900-1419
Practice Address - Street 1:2198 NE STEPHENS ST STE 101
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1410
Practice Address - Country:US
Practice Address - Phone:541-900-1418
Practice Address - Fax:541-900-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1134568629Medicaid