Healthcare Provider Details

I. General information

NPI: 1447186820
Provider Name (Legal Business Name): EVERBLOOM PEDIATRIC THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12985 SW 130TH CT SUITE 209, UNIT D
MIAMI FL
33186-5347
US

IV. Provider business mailing address

12985 SW 130TH CT SUITE 209, UNIT D
MIAMI FL
33186-5347
US

V. Phone/Fax

Practice location:
  • Phone: 305-417-0040
  • Fax: 786-228-4034
Mailing address:
  • Phone: 305-417-0040
  • Fax: 786-228-4034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: EVELYN ORNELAS
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: M.A., BCBA
Phone: 786-554-2253