Healthcare Provider Details

I. General information

NPI: 1326585316
Provider Name (Legal Business Name): BRIGHT CONNECTIONS OCCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 BLUE HERON DR
HIGHLAND MI
48357-3909
US

IV. Provider business mailing address

1243 BLUE HERON DR
HIGHLAND MI
48357-3909
US

V. Phone/Fax

Practice location:
  • Phone: 231-349-1942
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201009414
License Number StateMI

VIII. Authorized Official

Name: LAUREN VANDERLIST
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 231-349-1942