Healthcare Provider Details

I. General information

NPI: 1366338568
Provider Name (Legal Business Name): BLOSSOM & THRIVE THERAPY CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 N RIVERSIDE DR STE F
ESPANOLA NM
87532-2889
US

IV. Provider business mailing address

PO BOX 143
VADITO NM
87579-0143
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-2876
  • Fax:
Mailing address:
  • Phone: 505-660-5489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MEAGAN ROMERO
Title or Position: CO-OWNER
Credential: OTR/L
Phone: 505-660-5489