Healthcare Provider Details

I. General information

NPI: 1295618601
Provider Name (Legal Business Name): STARLIGHT SPROUTS THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7533 S CENTER VIEW CT # 4990
WEST JORDAN UT
84084-5526
US

IV. Provider business mailing address

8767 HEADLEY DR
STERLING HEIGHTS MI
48314-2661
US

V. Phone/Fax

Practice location:
  • Phone: 954-932-5958
  • Fax:
Mailing address:
  • Phone: 954-932-5958
  • 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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROSEMARIE BAUTISTA
Title or Position: OWNER
Credential:
Phone: 954-932-5958