Healthcare Provider Details

I. General information

NPI: 1578480117
Provider Name (Legal Business Name): LIFE AND LIGHT THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 LYMAN AVE
BALTIMORE MD
21212-3512
US

IV. Provider business mailing address

413 LYMAN AVE
BALTIMORE MD
21212-3512
US

V. Phone/Fax

Practice location:
  • Phone: 443-854-3059
  • Fax: 443-869-2525
Mailing address:
  • Phone: 443-854-3059
  • Fax: 443-869-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ABIMBOLA ADEWUMI
Title or Position: DIRECTOR
Credential: BSN
Phone: 443-854-3059