The Shine Pediatric Therapy Center

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

THE SHINE PEDIATRIC THERAPY CENTER

Practice address

921 W Missouri Ave
Chickasha, OK 73018-4328

Phone

(405) 612-8396

NPI assigned

Apr 12, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Justin Wonderly

Title

Owner

Phone

(405) 708-7172

Specialties & licenses 1

Addresses

Other names 1

• Shine Pediatric Therapy Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681257600000",
    "number": "1023704236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 W MISSOURI AVE",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730184328",
            "telephone_number": "405-612-8396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 W MISSOURI AVE",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730184328",
            "telephone_number": "405-612-8396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SHINE PEDIATRIC THERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-12",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A",
        "authorized_official_last_name": "WONDERLY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-708-7172"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shine Pediatric Therapy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Corinna Taylor
• Justin Taylor
• Dana Dale Terry, PT
• The Ark Mental Health Trauma Center
• The Lighthouse Guidance Center LLC
• Therapies United
• Thomas Family Care LLC
• Thomas Family Care,LLC
• Alexandria P Thompson, APRN, FNP-C
• Deborah Tiger, LPC-C

• Occupational Therapist in Chickasha, OK
• Providers in Chickasha, OK by specialty
• Occupational Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.