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General NPI Number Information
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NPI Number | 1053120592
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Entity Type | Organization
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Legal Business Name | PRIME LIGHT HEALTH SERVICES
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 1319 WOODBRIDGE STATION WAY STE 101
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City | EDGEWOOD
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State | MD
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Zip | 21040-3852
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 1319 WOODBRIDGE STATION WAY STE 101
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City | EDGEWOOD
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State | MD
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Zip | 21040
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Country | US
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Telephone | 443-857-7975
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Fax |
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Authorized Official
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Title or Position | COTA/L
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Name | SHAKIRAT O AROWOROWON
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Credential | OT
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Telephone | 443-857-7475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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