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Organization

LUMEN PEDIATRIC THERAPY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WAYNE KVINTUS (CHIEF EXECUTIVE OFFICER)
(313) 550-6258
Entity
Organization

Contact information

Practice address
26210 HARPER AVE STE 200, SAINT CLAIR SHORES, MI 48081-2203
(888) 485-8636
(586) 218-3367
Mailing address
26210 HARPER AVE STE 200, SAINT CLAIR SHORES, MI 48081-2203
(888) 485-8636

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
225X00000X
Occupational Therapist
235Z00000X
Speech-Language Pathologist

Other

Enumeration date
06/14/2022
Last updated
04/27/2026
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