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General NPI Number Information
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NPI Number | 1164076832
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Entity Type | Organization
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Legal Business Name | LIGHT THE WAY PEDIATRIC THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 107 MANOR AVE STE 204
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City | BARDSTOWN
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State | KY
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Zip | 40004-2800
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Country | US
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Telephone | 502-233-1305
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Fax | 502-509-0612
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Provider Business Mailing Address
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Address Line | 130 CHESTER HAHN RD
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City | BLOOMFIELD
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State | KY
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Zip | 40008-7014
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Country | US
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Telephone | 862-268-6139
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Fax |
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Authorized Official
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Title or Position | OWNER, SPEECH-LANGUAGE PATHOLOGIST
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Name | SAMANTHA LYNN LYNCH
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Credential |
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Telephone | 862-268-6139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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 #3
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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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