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General NPI Number Information
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NPI Number | 1366338568
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Entity Type | Organization
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Legal Business Name | BLOSSOM & THRIVE THERAPY CO LLC
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 745 N RIVERSIDE DR STE F
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City | ESPANOLA
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State | NM
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Zip | 87532-2889
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Country | US
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Telephone | 575-770-2876
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 143
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City | VADITO
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State | NM
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Zip | 87579-0143
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Country | US
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Telephone | 575-770-2876
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MEAGAN ROMERO
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Credential | OTR/L
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Telephone | 575-770-2876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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