Provider Demographics
NPI:1841777885
Name:BLOOMER, VICTORIA (COTA)
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:
Last Name:BLOOMER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CHRISTIAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1199
Mailing Address - Country:US
Mailing Address - Phone:413-528-7121
Mailing Address - Fax:413-528-2576
Practice Address - Street 1:151 CHRISTIAN HILL RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1199
Practice Address - Country:US
Practice Address - Phone:413-528-7121
Practice Address - Fax:413-528-2576
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1840224Z00000X
MA4346224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant