Organization
BLOOM THERAPY SERVICES
Active
Organization
BLOOM THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATY KENT (OTR/L)
(870) 904-3412
Entity
Organization
Contact information
Practice address
3311 FAIRFIELD AVE, SHREVEPORT, LA 71104-4103
(870) 904-3412
Mailing address
3311 FAIRFIELD AVE, SHREVEPORT, LA 71104-4103
(870) 904-3412
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2445243
—
LA
Enumeration date
05/27/2024
Last updated
05/27/2024
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