Organization
BLOOM PEDIATRIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLI HURD MSOT, OTR/L (PRESIDENT)
(678) 967-1924
Entity
Organization
Contact information
Practice address
14557 HIGHWAY 19 STE C, GRIFFIN, GA 30224-9582
(678) 967-1924
Mailing address
136 MAIN ST, MILNER, GA 30257-3844
(678) 967-1924
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
02/14/2023
Last updated
03/26/2026
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