Organization
BLOOM CHILDREN'S THERAPY
Active
Organization
BLOOM CHILDREN'S THERAPY
Active
Other names
Nicole LaRose, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE LAROSE MSR, OTR/L (OWNER)
(843) 425-7963
Entity
Organization
Contact information
Practice address
85C VINCENT DRIVE, MT PLEASANT, SC 29464
(843) 425-7963
(888) 588-3421
Mailing address
BLOOM CHILDREN'S THERAPY, 1154 ELIZABETH CT., MT PLEASANT, SC 29464
(843) 425-7963
(888) 588-3421
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
3326
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP6727
—
SC
05
—
TH2846
—
SC
Enumeration date
10/20/2014
Last updated
02/24/2021
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