Healthcare Provider Details

I. General information

NPI: 1952166019
Provider Name (Legal Business Name): GUIDING LIGHT OT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5217 ANDRITHS AVE
WARREN MI
48091-1212
US

IV. Provider business mailing address

7408 HEATHERWOOD DR APT 2A
GRAND BLANC MI
48439-7540
US

V. Phone/Fax

Practice location:
  • Phone: 586-210-6787
  • Fax:
Mailing address:
  • Phone: 623-680-9681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KAITLYN LEIGH LANDESS
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: OTD, OTR/L
Phone: 586-210-6787