Provider Demographics
NPI:1821233248
Name:BLOOM, LAURA COHEN (MHS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:COHEN
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MHS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11720 SW 122ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5033
Mailing Address - Country:US
Mailing Address - Phone:305-283-8860
Mailing Address - Fax:
Practice Address - Street 1:11720 SW 122ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5033
Practice Address - Country:US
Practice Address - Phone:305-283-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889797200Medicaid