Individual
BLOSSOM PETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 FOURTH ST APT Q24, ATHENS, GA 30601-4416
(518) 637-6124
Mailing address
700 FOURTH ST APT Q24, ATHENS, GA 30601-4416
(518) 637-6124
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
25-467245
GA
Other
Enumeration date
06/16/2026
Last updated
06/16/2026
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