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Organization

BLOSSOM THERAPEUTICS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JENNIFER CLARK JOHNSON OTR/L (THERAPIST/OWNER)
(541) 604-0548
Entity
Organization

Contact information

Practice address
408 NE HAWTHORNE AVE, BEND, OR 97701-4729
(541) 617-8769
(541) 668-6772
Mailing address
1757 NW FIELDS ST, BEND, OR 97703-7317
(541) 604-0548
(541) 668-6772

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary

Other

Enumeration date
11/05/2018
Last updated
11/05/2018
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