Healthcare Provider Details

I. General information

NPI: 1508774340
Provider Name (Legal Business Name): FULL BLOOM OCCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 UPHAM ST
MADISON WI
53704-4971
US

IV. Provider business mailing address

2560 UPHAM ST
MADISON WI
53704-4971
US

V. Phone/Fax

Practice location:
  • Phone: 847-224-2052
  • Fax:
Mailing address:
  • Phone: 847-224-2052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LIA STRATTON
Title or Position: SOLE MEMBER/OWNER
Credential: MS, OTR/L
Phone: 847-224-2052