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General NPI Number Information
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NPI Number | 1295618601
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Entity Type | Organization
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Legal Business Name | STARLIGHT SPROUTS THERAPIES, LLC
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 7533 S CENTER VIEW CT # 4990
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City | WEST JORDAN
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State | UT
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Zip | 84084-5526
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Country | US
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Telephone | 954-932-5958
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Fax |
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Provider Business Mailing Address
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Address Line | 8767 HEADLEY DR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-2661
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Country | US
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Telephone | 954-932-5958
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROSEMARIE BAUTISTA
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Credential |
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Telephone | 954-932-5958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 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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