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General NPI Number Information
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NPI Number | 1356093223
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Entity Type | Individual
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Provider Name | BLOSSOM MARSHALL
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Gender | Female
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 8520 NW 46TH CT
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City | LAUDERHILL
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State | FL
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Zip | 33351-5425
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Country | US
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Telephone | 954-572-3135
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Fax |
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Provider Business Mailing Address
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Address Line | 3338 NW 22ND ST
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33311-2714
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Country | US
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Telephone | 954-309-6858
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Fax | 754-551-6178
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | FL
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