Healthcare Provider Details

I. General information

NPI: 1164152872
Provider Name (Legal Business Name): BLOSSOM PEDIATRIC THERAPY PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 COUNTRY CLUB RD SUITE A
COLUMBUS OH
43213
US

IV. Provider business mailing address

1021 COUNTRY CLUB RD SUITE A
COLUMBUS OH
43213
US

V. Phone/Fax

Practice location:
  • Phone: 614-383-8047
  • Fax: 380-800-4608
Mailing address:
  • Phone: 614-383-8047
  • Fax: 380-800-4608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HAYLEY SMITH
Title or Position: DIRECTOR OF CLINIC OPERATIONS
Credential: BBA
Phone: 614-383-8717