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General NPI Number Information
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NPI Number | 1588563241
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Entity Type | Individual
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Provider Name | KAITLIN D BLOOM
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Gender | Female
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 121 PROGRESS AVE
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City | POTTSVILLE
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State | PA
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Zip | 17901-2968
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Country | US
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Telephone | 570-234-3989
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Fax |
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Provider Business Mailing Address
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Address Line | 446 ARLINGTON ST
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City | TAMAQUA
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State | PA
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Zip | 18252-2104
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Country | US
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Telephone | 570-710-0530
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | BH005060
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License Number State | PA
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