Provider Demographics
NPI:1730836321
Name:HOLISTIC BLOSSOM PEDIATRIC THERAPY
Entity type:Organization
Organization Name:HOLISTIC BLOSSOM PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:504-717-8172
Mailing Address - Street 1:525 WOODLAND SQUARE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-2212
Mailing Address - Country:US
Mailing Address - Phone:504-717-8172
Mailing Address - Fax:
Practice Address - Street 1:525 WOODLAND SQUARE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-2212
Practice Address - Country:US
Practice Address - Phone:504-717-8172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty