Dominique Nicole Light, MOTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

0119007097 Issued in MD

Practice address

176 W University Pkwy Ste E
Jackson, TN 38305-1618

Phone

(313) 004-9507

Fax

(731) 300-4951

NPI assigned

Sep 19, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dominique Nicole Hardaway Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Care Walk in Clinic, Inc.

  • Family Medicine Physician
  • Jackson, TN
  • NPI 1457302598
  NPD (past)
• Exceptional Childrens Center, LLC

  • Pediatric Occupational Therapist
  • Alexandria, VA
  • NPI 1558560631

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697932800000",
    "number": "1265980304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7001A LOISDALE RD",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221501904",
            "telephone_number": "703-971-0602",
            "fax_number": "703-971-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 W UNIVERSITY PKWY STE E",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051618",
            "telephone_number": "313-004-9507",
            "fax_number": "731-300-4951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIGHT",
        "first_name": "DOMINIQUE",
        "middle_name": "NICOLE",
        "credential": "MOTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-19",
        "last_updated": "2023-10-22",
        "certification_date": "2023-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "MD",
            "license": "0119007097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOMINIQUE",
            "last_name": "HARDAWAY",
            "middle_name": "NICOLE",
            "credential": "MOTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lifestyle Eye Care PLLC
• Lifeworks Behavioral Health Inc
• Lifeworks Resources, LLC
• Lift Therapy, Inc.
• Lift Therapy, Inc.
• Suzanne Josephine Lim-Luy, P.T.
• Peter Lin, M.D
• Lincare Inc
• Alisa Jean Lindley, O.D.
• Kim Lindsey-Goodrich, PHARMD

• Pediatric Occupational Therapist in Jackson, TN
• Providers in Jackson, TN by specialty
• Pediatric Occupational Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 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.