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General NPI Number Information
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NPI Number | 1447186820
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Entity Type | Organization
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Legal Business Name | EVERBLOOM PEDIATRIC THERAPY GROUP
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 12985 SW 130TH CT SUITE 209, UNIT D
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City | MIAMI
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State | FL
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Zip | 33186-5347
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Country | US
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Telephone | 305-417-0040
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Fax | 786-228-4034
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Provider Business Mailing Address
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Address Line | 12985 SW 130TH CT SUITE 209, UNIT D
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City | MIAMI
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State | FL
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Zip | 33186-5347
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Country | US
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Telephone | 305-417-0040
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Fax | 786-228-4034
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Authorized Official
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Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
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Name | EVELYN ORNELAS
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Credential | M.A., BCBA
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Telephone | 786-554-2253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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