# BLOOM CREATIVE ARTS AND THERAPY CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215467188
- **Authorized official:** MEGAN COLTONIAK (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (716) 982-5170

## Contact information

- **Practice address:** 7821 ERIE RD, DERBY, NY 14047-9502
- **Practice address phone:** (716) 549-0585
- **Mailing address:** 73 ROVNER PL, HAMBURG, NY 14075-4205

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 06/14/2017
- **Last updated:** 12/05/2023