# LIGHT OF MINE PEDIATRIC AND ADOLESCENT THERAPY SERVICES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689228272
- **Authorized official:** MRS. MEGAN HOFFMAN MOTR/L (OWNER/DIRECTOR, MOTR/L)
- **Authorized official phone:** (918) 520-6166

## Contact information

- **Practice address:** 4517 S. YELLOW PINE AVE., BROKEN ARROW, OK 74011-5616
- **Practice address phone:** (918) 520-6166
- **Mailing address:** 4517 S. YELLOW PINE AVE., BROKEN ARROW, OK 74011-5616
- **Mailing address phone:** (918) 520-6166

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | — | NULL | Yes |
| 225X00000X | Occupational Therapist | — | — | Yes |

## Other

- **Enumeration date:** 07/31/2019
- **Last updated:** 07/31/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201224190A | — | KS |