Provider Demographics
NPI:1023542578
Name:BLOSSOM THERAPIES OF FLORIDA
Entity Type:Organization
Organization Name:BLOSSOM THERAPIES OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAILEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:727-310-4134
Mailing Address - Street 1:1803 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2714
Mailing Address - Country:US
Mailing Address - Phone:727-310-4134
Mailing Address - Fax:
Practice Address - Street 1:1803 FOREST DR
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-2714
Practice Address - Country:US
Practice Address - Phone:727-310-4134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 14170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty