MEDICARE: BUD TO BLOOM, 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	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1093563298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUD TO BLOOM, LLC

Provider Business Mailing Address
First Line	:	3619 LEDGESTONE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-6012
Country	:	US
Telephone Number	:	281-610-0451
Fax Number	:

Provider Business Practice Location Address
First Line	:	3619 LEDGESTONE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-6012
Country	:	US
Telephone Number	:	281-610-0451
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	ELIZABETH ARIZPE
Credential	:	OTR
Telephone Number	:	281-610-0451

Provider Enumeration Date	:	05/11/2024
Last Update Date	:	05/23/2024

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Directions to “BUD TO BLOOM, LLC ” Practice Location

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