Healthcare Provider Details

I. General information

NPI: 1225853799
Provider Name (Legal Business Name): BLOOM THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5639 ELMORE RD
ELMORE AL
36025-1605
US

IV. Provider business mailing address

5639 ELMORE RD
ELMORE AL
36025-1605
US

V. Phone/Fax

Practice location:
  • Phone: 334-478-3350
  • Fax: 334-478-3261
Mailing address:
  • Phone: 334-478-3350
  • Fax: 334-478-3261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KELLY DAVIS HARPER
Title or Position: OWNER
Credential: MS, CCC-SLP
Phone: 334-478-3350