Healthcare Provider Details

I. General information

NPI: 1619653805
Provider Name (Legal Business Name): BLOOM OT AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 TALL PINES LN
HORSHAM PA
19044-1802
US

IV. Provider business mailing address

607 TALL PINES LN
HORSHAM PA
19044-1802
US

V. Phone/Fax

Practice location:
  • Phone: 215-971-5697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOAN DOBERSTEIN
Title or Position: OWNER, OCCUPATIONAL THERAPIST
Credential: MS,OTR/L
Phone: 215-971-5697