Provider Demographics
NPI:1538041124
Name:LIGHT MINDED OT PLLC
Entity type:Organization
Organization Name:LIGHT MINDED OT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GEMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:919-802-5805
Mailing Address - Street 1:3101 SUMMIT CV APT 207
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3980
Mailing Address - Country:US
Mailing Address - Phone:919-802-5805
Mailing Address - Fax:
Practice Address - Street 1:3101 SUMMIT CV APT 207
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3980
Practice Address - Country:US
Practice Address - Phone:919-802-5805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty