Organization
LIGHT OF MINE PEDIATRIC AND ADOLESCENT THERAPY SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MEGAN HOFFMAN MOTR/L (OWNER/DIRECTOR, MOTR/L)
(918) 520-6166
Entity
Organization
Contact information
Practice address
4517 S. YELLOW PINE AVE., BROKEN ARROW, OK 74011-5616
(918) 520-6166
Mailing address
4517 S. YELLOW PINE AVE., BROKEN ARROW, OK 74011-5616
(918) 520-6166
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201224190A
—
KS
Enumeration date
07/31/2019
Last updated
07/31/2019
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