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General NPI Number Information
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NPI Number | 1164152872
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Entity Type | Organization
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Legal Business Name | BLOSSOM PEDIATRIC THERAPY PARTNERS
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 06/17/2022
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Provider Practice Location Address
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Address Line | 411 WOLF LEDGES PKWY
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City | AKRON
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State | OH
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Zip | 44311-1028
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Country | US
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Telephone | 216-401-6698
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Fax |
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Provider Business Mailing Address
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Address Line | 411 WOLF LEDGES PKWY
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City | AKRON
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State | OH
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Zip | 44311-1028
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER / SPEECH THERAPIST
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Name | CASSIDY LONGVILLE LONGVILLE
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Credential | MA
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Telephone | 216-401-6698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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