Provider Demographics
NPI:1225862337
Name:BORN TO BLOOM PEDIATRIC THERAPY
Entity type:Organization
Organization Name:BORN TO BLOOM PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CORIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:INTRIERI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:618-570-1874
Mailing Address - Street 1:2431 GLENMOUNT CT
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-8803
Mailing Address - Country:US
Mailing Address - Phone:618-570-1874
Mailing Address - Fax:
Practice Address - Street 1:2431 GLENMOUNT CT
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-8803
Practice Address - Country:US
Practice Address - Phone:618-570-1874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency