Provider Demographics
NPI:1457919144
Name:STARLIGHT THERAPY, LLC
Entity Type:Organization
Organization Name:STARLIGHT THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR
Authorized Official - Phone:720-985-5165
Mailing Address - Street 1:9389 W UTE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-6988
Mailing Address - Country:US
Mailing Address - Phone:720-985-5165
Mailing Address - Fax:
Practice Address - Street 1:9389 W UTE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-6988
Practice Address - Country:US
Practice Address - Phone:720-985-5165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty