NPIMap

Organization Active NPI

Shining Stars Therapy, PA

  • Developmental Therapist
  • Fuquay Varina, NC
National Provider Identifier
1245534338
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental TherapistTaxonomy code 222Q00000X
License
6790 Issued in NC
Legal business name
SHINING STARS THERAPY, PA
Practice address
304 Judd Place Drive
Fuquay Varina, NC 27526-2210
Phone
(919) 557-8305
NPI assigned
Jan 4, 2011
Last updated
Nov 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2016

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

Authorized official

Name
Dawn Marie Solomon, OTR/LNPI 1659505816
Title
Occupational Therapist/Owner
Phone
(919) 557-8305

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X 6790 NC
Developmental Therapist 222Q00000X 6790 NC Primary

Addresses

Primary practice location

304 Judd Place Drive
Fuquay Varina, NC 27526-2210

Mailing address

304 Judd Place Drive
Fuquay Varina, NC 27526-2210
Phone (919) 557-8305

Other identifiers 1

IdentifierTypeStateIssuer
7200363MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Shining Stars Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

304 Judd Place Dr
Fuquay Varina, NC 27526
Phone (919) 557-8305

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1294099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1245534338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 JUDD PLACE DRIVE",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275262210",
            "telephone_number": "919-557-8305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 JUDD PLACE DRIVE",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275262210",
            "telephone_number": "919-557-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINING STARS THERAPY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-04",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "SOLOMON",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "919-557-8305",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NC",
            "license": "6790",
            "primary": false
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "NC",
            "license": "6790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7200363",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fuquay Varina, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; 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.