Provider Demographics
NPI:1033360243
Name:BLOOM, JOANNE E
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:E
Last Name:BLOOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 RANDALL DR
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-6071
Mailing Address - Country:US
Mailing Address - Phone:570-847-3449
Mailing Address - Fax:
Practice Address - Street 1:800 COURT ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2818
Practice Address - Country:US
Practice Address - Phone:570-286-7121
Practice Address - Fax:570-286-2418
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002582L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant