Provider Demographics
NPI:1922388107
Name:BLOOM, GAIL M (OTD, MA, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:M
Last Name:BLOOM
Suffix:
Gender:F
Credentials:OTD, MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1249
Mailing Address - Country:US
Mailing Address - Phone:978-409-2233
Mailing Address - Fax:
Practice Address - Street 1:27 SOMERSET DR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1249
Practice Address - Country:US
Practice Address - Phone:978-409-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist