Provider Demographics
NPI:1134905292
Name:KIDS IN BLOOM OCCUPATIONAL THERAPY, PLLC
Entity type:Organization
Organization Name:KIDS IN BLOOM OCCUPATIONAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:208-240-2820
Mailing Address - Street 1:3808 WOOD RD STE 106
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:ID
Mailing Address - Zip Code:83455-5352
Mailing Address - Country:US
Mailing Address - Phone:208-240-2820
Mailing Address - Fax:208-656-5647
Practice Address - Street 1:1420 N HIGHWAY 33 STE 106
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5313
Practice Address - Country:US
Practice Address - Phone:208-240-2820
Practice Address - Fax:208-656-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty