Provider Demographics
NPI:1164003638
Name:BRIGHT SPOT PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:BRIGHT SPOT PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANSCHAGRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-303-7439
Mailing Address - Street 1:100 E WHITESTONE BLVD
Mailing Address - Street 2:STE 148 #238
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1613 DUBIEL DR
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-4212
Practice Address - Country:US
Practice Address - Phone:334-303-7439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty