Shining Star Therapy LLC

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

14821 Issued in FL

Legal business name

SHINING STAR THERAPY LLC

Practice address

8341 Old Town Dr
Tampa, FL 33647-3335

Phone

(708) 715-2555

Fax

(708) 221-6638

NPI assigned

Sep 1, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Mylene Braggs, OTR/L

Title

Member

Phone

(708) 715-2555

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1314835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314835200000",
    "number": "1457632606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8341 OLD TOWN DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336473335",
            "telephone_number": "708-715-2555",
            "fax_number": "708-221-6638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8341 OLD TOWN DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336473335",
            "telephone_number": "708-715-2555",
            "fax_number": "708-221-6638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINING STAR THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-01",
        "last_updated": "2011-09-01",
        "status": "A",
        "authorized_official_last_name": "BRAGGS",
        "authorized_official_first_name": "MYLENE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "708-715-2555",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "FL",
            "license": "14821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jae Y Shin, MD
• Jennifer E Shin, MD
• Shine Counseling Tampa
• Camille Shine, CRNA
• Shining Minds Psychiatry and Wellness Limited Liability Company
• Kaitlin Shinn
• Haley Shipper
• Shiraz Khaiser MD PA
• Jordan Leigh Shireman, PA-C
• Jennifer Shiroky-Kochavi, MD

• Pediatric Occupational Therapist in Tampa, FL
• Providers in Tampa, FL by specialty
• Pediatric Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2011; 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.