NPIMap

Organization Active NPI

Light of Mine Pediatric and Adolescent Therapy Services, PLLC

  • Occupational Therapist
  • Broken Arrow, OK
National Provider Identifier
1689228272
Registry record updated Jul 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
LIGHT OF MINE PEDIATRIC AND ADOLESCENT THERAPY SERVICES, PLLC
Practice address
4517 S. Yellow Pine Ave.
Broken Arrow, OK 74011-5616
Phone
(918) 520-6166
NPI assigned
Jul 31, 2019
Last updated
Jul 31, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2019

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

Authorized official

Name
Mrs. Megan Hoffman, MOTR/LNPI 1093160400
Title
Owner/Director, Motr/L
Phone
(918) 520-6166

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

4517 S. Yellow Pine Ave.
Broken Arrow, OK 74011-5616

Mailing address

4517 S. Yellow Pine Ave.
Broken Arrow, OK 74011-5616
Phone (918) 520-6166

Other identifiers 1

IdentifierTypeStateIssuer
201224190AMedicaidKS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564531200000",
    "number": "1689228272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4517 S. YELLOW PINE AVE.",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740115616",
            "telephone_number": "918-520-6166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4517 S. YELLOW PINE AVE.",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740115616",
            "telephone_number": "918-520-6166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHT OF MINE PEDIATRIC AND ADOLESCENT THERAPY SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-31",
        "last_updated": "2019-07-31",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "OWNER/DIRECTOR, MOTR/L",
        "authorized_official_telephone_number": "918-520-6166",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MOTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201224190A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; 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.