MEDICARE: BLOOM THERAPY COLUMBUS, 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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1316713746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM THERAPY COLUMBUS, LLC

Provider Business Mailing Address
First Line	:	4824 CALVIN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4824 CALVIN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2129
Country	:	US
Telephone Number	:	513-518-2482
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST/OWNER
Name	:	SHERIDAN LEIGH SEITZ
Credential	:	OTD, OTR/L
Telephone Number	:	513-518-2482

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	11/27/2023

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