Organization
BLOOM AND GROW PEDIATRIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA SHEDDEN SLP-CCC (OWNER)
(859) 229-0487
Entity
Organization
Contact information
Practice address
208 SAWYER CIR UNIT 413, CHARLESTON, SC 29492-8624
(859) 229-0487
Mailing address
208 SAWYER CIR UNIT 413, CHARLESTON, SC 29492-8624
(859) 229-0487
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA2157
—
SC
Enumeration date
05/09/2022
Last updated
05/09/2022
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