Provider Demographics
NPI:1164289658
Name:BLOSSOM BEYOND BOUNDARIES LLC
Entity type:Organization
Organization Name:BLOSSOM BEYOND BOUNDARIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:484-769-9359
Mailing Address - Street 1:3212 LEHIGH ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-3230
Mailing Address - Country:US
Mailing Address - Phone:484-769-9359
Mailing Address - Fax:
Practice Address - Street 1:3212 LEHIGH ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3230
Practice Address - Country:US
Practice Address - Phone:484-769-9359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty