MEDICARE: BLOSSOM ABA OH 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1043195787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM ABA OH LLC

Provider Business Mailing Address
First Line	:	229 ROUTE 70 STE 100
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-1026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2646 MILTON RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-4616
Country	:	US
Telephone Number	:	857-327-5283
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHAD KAUFMAN
Credential	:
Telephone Number	:	857-327-5283

Provider Enumeration Date	:	08/11/2025
Last Update Date	:	08/11/2025

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Directions to “BLOSSOM ABA OH LLC ” Practice Location

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