Provider Demographics
NPI:1891962742
Name:BLOOME, CATHERINE ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ANN
Last Name:BLOOME
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 NE 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3630
Mailing Address - Country:US
Mailing Address - Phone:503-913-5273
Mailing Address - Fax:503-914-0468
Practice Address - Street 1:1404 NE 58TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3630
Practice Address - Country:US
Practice Address - Phone:503-913-5273
Practice Address - Fax:503-914-0468
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002851225X00000X, 225XE1200X
OR1006341225X00000X, 225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500629360Medicaid
ORR157477Medicare PIN
ORR157474Medicare PIN
WAG8897515Medicare PIN
OR500629360Medicaid
ORR157476Medicare PIN
ORR157666Medicare PIN
ORR157475Medicare PIN