Provider Demographics
NPI:1992121818
Name:BLOSSOMS PEDIATRIC OCCUPATIONAL THERAPY LLC.
Entity type:Organization
Organization Name:BLOSSOMS PEDIATRIC OCCUPATIONAL THERAPY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, OTR/L
Authorized Official - Phone:973-832-7266
Mailing Address - Street 1:1501 HAMBURG TURNPIKE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-832-7266
Mailing Address - Fax:973-694-3201
Practice Address - Street 1:1501 HAMBURG TURNPIKE
Practice Address - Street 2:SUITE 305
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-832-7266
Practice Address - Fax:973-694-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00378600225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty