Provider Demographics
NPI:1902118854
Name:BRIGHT, KRISTY NICOLE (OT)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:NICOLE
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:NICOLE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3959 N SHEEDY AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-8103
Mailing Address - Country:US
Mailing Address - Phone:417-300-1997
Mailing Address - Fax:
Practice Address - Street 1:3545 S. NATIONAL AVE. COXHEALTH OUTPATIENT REHABILITATI
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-269-5500
Practice Address - Fax:417-269-5508
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003004955225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist