MEDICARE: BLOOM DEVELOPMENTAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1033055462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM DEVELOPMENTAL SERVICES LLC

Provider Business Mailing Address
First Line	:	5185 DUNDEE AVE
Second Line	:
City	:	DE LEON SPRINGS
State	:	FL
Zip	:	32130-3457
Country	:	US
Telephone Number	:	727-698-6564
Fax Number	:

Provider Business Practice Location Address
First Line	:	5185 DUNDEE AVE
Second Line	:
City	:	DE LEON SPRINGS
State	:	FL
Zip	:	32130-3457
Country	:	US
Telephone Number	:	727-698-6564
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. MICHELE MARGARET MCDONOUGH
Credential	:
Telephone Number	:	727-698-6564

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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