=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295693174
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INNER BLOOM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2026
-----------------------------------------------------
Last Update Date | 01/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 657 BRIDGEWATER CENTER RD
-----------------------------------------------------
City | BRIDGEWATER CORNERS
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05035-9114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-443-6433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 184
-----------------------------------------------------
City | BRIDGEWATER CORNERS
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05035-0184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-443-6433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | STEPHANIE SANDHERR
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 832-443-6433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------