Provider Demographics
NPI:1639310048
Name:TINY BLOOMERS THERAPY, INC.
Entity Type:Organization
Organization Name:TINY BLOOMERS THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:773-383-9539
Mailing Address - Street 1:1204 BLUEJAY LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-2461
Mailing Address - Country:US
Mailing Address - Phone:773-838-9539
Mailing Address - Fax:815-254-0217
Practice Address - Street 1:1204 BLUEJAY LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-2461
Practice Address - Country:US
Practice Address - Phone:773-838-9539
Practice Address - Fax:815-254-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency