Provider Demographics
NPI:1710569553
Name:BLOOM PEDIATRIC THERAPY, PLLC
Entity Type:Organization
Organization Name:BLOOM PEDIATRIC THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:ALINE RUMOHR
Authorized Official - Last Name:STONECIPHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:512-680-1925
Mailing Address - Street 1:220 N PROSPECT MANOR AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2332
Mailing Address - Country:US
Mailing Address - Phone:512-680-1925
Mailing Address - Fax:312-284-8874
Practice Address - Street 1:220 N PROSPECT MANOR AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2332
Practice Address - Country:US
Practice Address - Phone:512-680-1925
Practice Address - Fax:312-284-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty