Organization
SHINING STAR THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYLENE CORMIER OTR/L (PRESIDENT)
(815) 267-7334
Entity
Organization
Contact information
Practice address
13400 S ROUTE 59, SUITE# 116-326, PLAINFIELD, IL 60585-5696
(815) 267-7334
(630) 429-9411
Mailing address
13400 S ROUTE 59 STE 116-326, PLAINFIELD, IL 60585-5696
(815) 267-7334
(630) 429-9411
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
180.005672
IL
222Q00000X
Developmental Therapist
—
—
2251P0200X
Pediatric Physical Therapist
070.016938
IL
225XP0200X
Pediatric Occupational Therapist
Primary
056.004242
IL
235Z00000X
Speech-Language Pathologist
146.004828
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9932502
BCBS OF IL
IL
Enumeration date
03/26/2007
Last updated
10/29/2025
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