Healthcare Provider Details

I. General information

NPI: 1306740253
Provider Name (Legal Business Name): SHINE ON THE SPECTRUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48751 STRUCTURAL DR
CHESTERFIELD MI
48051-2664
US

IV. Provider business mailing address

48751 STRUCTURAL DR
CHESTERFIELD MI
48051-2664
US

V. Phone/Fax

Practice location:
  • Phone: 586-248-1241
  • Fax:
Mailing address:
  • Phone: 586-248-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: HEIDI PICKFORD
Title or Position: OWNER
Credential: OTR/L
Phone: 586-248-1241