NPIMap

Organization Active NPI

Bloom Children'S Therapy

  • Pediatric Occupational Therapist
  • Mt Pleasant, SC
National Provider Identifier
1497159446
Registry record updated Feb 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
3326 Issued in SC
Legal business name
BLOOM CHILDREN'S THERAPY
Practice address
85C Vincent Drive
Mt Pleasant, SC 29464
Phone
(843) 425-7963
Fax
(888) 588-3421
NPI assigned
Oct 20, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nicole Larose, MSR, OTR/LNPI 1992041735
Title
Owner
Phone
(843) 425-7963

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251P0200X
Pediatric Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225XP0200X 3326 SC Primary

Addresses

Primary practice location

85C Vincent Drive
Mt Pleasant, SC 29464

Mailing address

Bloom Children'S Therapy
1154 Elizabeth CT.
Mt Pleasant, SC 29464
Phone (843) 425-7963

Other identifiers 2

IdentifierTypeStateIssuer
TH2846MedicaidSC
GP6727MedicaidSC

Other names 1

  • Nicole LaRose, LLC Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614124800000",
    "number": "1497159446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BLOOM CHILDREN'S THERAPY",
            "address_2": "1154 ELIZABETH CT.",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "29464",
            "telephone_number": "843-425-7963",
            "fax_number": "888-588-3421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85C VINCENT DRIVE",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "29464",
            "telephone_number": "843-425-7963",
            "fax_number": "888-588-3421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM CHILDREN'S THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-20",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A",
        "authorized_official_last_name": "LAROSE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-425-7963",
        "authorized_official_credential": "MSR, OTR/L"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "SC",
            "license": "3326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TH2846",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6727",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nicole LaRose, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Mt Pleasant, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.