Provider Demographics
NPI:1366976490
Name:BRIGHT START
Entity type:Organization
Organization Name:BRIGHT START
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:484-942-8912
Mailing Address - Street 1:50 GLENGARRY CHASE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-8913
Mailing Address - Country:US
Mailing Address - Phone:484-942-8912
Mailing Address - Fax:
Practice Address - Street 1:50 GLENGARRY CHASE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-8913
Practice Address - Country:US
Practice Address - Phone:484-942-8912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-15
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005939225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003151587BMedicaid