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General NPI Number Information
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NPI Number | 1679287254
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Entity Type | Organization
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Legal Business Name | BORN TO BLOOM LLC
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 5305 LAKEWOOD CREEK AVE
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City | LAS VEGAS
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State | NV
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Zip | 89141
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Country | US
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Telephone | 678-480-1149
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Fax |
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Provider Business Mailing Address
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Address Line | 304 S JONES BLVD # 5654
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City | LAS VEGAS
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State | NV
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Zip | 89107-2623
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. QUANEKA HOSKIN-CHASE
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Credential | MS, OTR/L
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Telephone | 678-480-1149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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