Healthcare Provider Details

I. General information

NPI: 1083452528
Provider Name (Legal Business Name): BLOOMKIDZ INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 E PECOS RD STE 1
CHANDLER AZ
85225-6077
US

IV. Provider business mailing address

2141 E PECOS RD STE 1
CHANDLER AZ
85225-6077
US

V. Phone/Fax

Practice location:
  • Phone: 480-846-0607
  • Fax: 480-841-6696
Mailing address:
  • Phone: 480-846-0607
  • Fax: 480-841-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SCOTT FEAVEL
Title or Position: CEO
Credential:
Phone: 928-853-6052