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General NPI Number Information
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NPI Number | 1679373575
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Entity Type | Organization
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Legal Business Name | BLOOM PEDIATRIC REHABILITATION
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 220 S MAIN ST STE 120
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City | ROYAL OAK
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State | MI
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Zip | 48067-2678
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Country | US
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Telephone | 248-270-2641
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Fax |
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Provider Business Mailing Address
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Address Line | 2924 PAXTON ST
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City | FERNDALE
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State | MI
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Zip | 48220-1068
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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 | CO-OWNER
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Name | MISS MICHAELA BUCKLEY
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Credential | M.A., CCC- SLP
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Telephone | 248-270-2641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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