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General NPI Number Information
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NPI Number | 1326585316
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Entity Type | Organization
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Legal Business Name | BRIGHT CONNECTIONS OCCUPATIONAL THERAPY LLC
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Dates
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Enumeration Date | 01/27/2017
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 1243 BLUE HERON DR
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City | HIGHLAND
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State | MI
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Zip | 48357-3909
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Country | US
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Telephone | 231-349-1942
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Fax |
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Provider Business Mailing Address
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Address Line | 1243 BLUE HERON DR
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City | HIGHLAND
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State | MI
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Zip | 48357-3909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | LAUREN VANDERLIST
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Credential | OTR/L
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Telephone | 231-349-1942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 5201009414
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License Number State | MI
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