MEDICARE: BLOOM PEDIATRIC THERAPY SERVICES INC

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
2	225X00000X	Occupational Therapist	OTR1436	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871618173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM PEDIATRIC THERAPY SERVICES INC

Provider Business Mailing Address
First Line	:	1007 WINDOVER RD STE A
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-6009
Country	:	US
Telephone Number	:	870-520-0646
Fax Number	:	870-520-5034

Provider Business Practice Location Address
First Line	:	1007 WINDOVER RD STE A
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-6009
Country	:	US
Telephone Number	:	870-520-0646
Fax Number	:	870-520-5034

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOCELYN JOHNSON
Credential	:
Telephone Number	:	870-919-3141

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	03/11/2026

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Directions to “BLOOM PEDIATRIC THERAPY SERVICES INC ” Practice Location

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