Provider Demographics
NPI:1952166019
Name:GUIDING LIGHT OT, LLC
Entity type:Organization
Organization Name:GUIDING LIGHT OT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:LANDESS
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:586-210-6787
Mailing Address - Street 1:7408 HEATHERWOOD DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7540
Mailing Address - Country:US
Mailing Address - Phone:623-680-9681
Mailing Address - Fax:
Practice Address - Street 1:5217 ANDRITHS AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1212
Practice Address - Country:US
Practice Address - Phone:586-210-6787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1235746249Medicaid