MEDICARE: BLOSSOM & THRIVE THERAPY CO 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	235Z00000X	Speech-Language Pathologist
2	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1366338568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM & THRIVE THERAPY CO LLC

Provider Business Mailing Address
First Line	:	PO BOX 143
Second Line	:
City	:	VADITO
State	:	NM
Zip	:	87579-0143
Country	:	US
Telephone Number	:	505-660-5489
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 N RIVERSIDE DR STE F
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-2889
Country	:	US
Telephone Number	:	575-770-2876
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MEAGAN ROMERO
Credential	:	OTR/L
Telephone Number	:	505-660-5489

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	01/29/2026

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Directions to “BLOSSOM & THRIVE THERAPY CO LLC ” Practice Location

Language	Start Address	Practice Location

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