Bloom Pediatric Rehabilitation

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

BLOOM PEDIATRIC REHABILITATION

Practice address

220 S Main St Ste 120
Royal Oak, MI 48067-2678

Phone

(248) 270-2641

NPI assigned

Mar 18, 2025

Organization subpart

No

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

Authorized official

Name

Miss Michaela Buckley, M.A., CCC- SLPNPI 1679289680

Title

Co-Owner

Phone

(248) 270-2641

Specialties & licenses 1

Addresses

Other names 1

• Bloom Pediatric Rehabilitation Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 3

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

• Michaela Ann Buckley, CCC-SLP

  • Speech-Language Pathologist
  • Royal Oak, MI
  • NPI 1679289680
  Medicare reassignment NPD Authorized official
• Melanie Burnham

  • Speech-Language Pathologist
  • Royal Oak, MI
  • NPI 1902544786
  Medicare reassignment NPD
• Julia Woodford, OTRL

  • Pediatric Occupational Therapist
  • Clinton TWP, MI
  • NPI 1912728809
  Medicare reassignment NPD

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

{
    "created_epoch": "1742256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749772800000",
    "number": "1679373575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2924 PAXTON ST",
            "city": "FERNDALE",
            "state": "MI",
            "postal_code": "482201068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 S MAIN ST STE 120",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480672678",
            "telephone_number": "248-270-2641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM PEDIATRIC REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-18",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-04",
        "status": "A",
        "authorized_official_last_name": "BUCKLEY",
        "authorized_official_first_name": "MICHAELA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "248-270-2641",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "M.A., CCC- SLP"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloom Pediatric Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bloom Pediatric Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brooke Blasen, DO
• Jack Jeffrey Blaszkowski
• Neal Benjamin Blatt, M.D.
• Ann Marie Blenc, M.D.
• Rachel Blind, NP
• Richard John Bloomingdale, MD
• Blue Springs Physical Therapy LLC
• Danielle Bluford
• Adina M Blum, O.D.
• Madeleine Blum

• Rehabilitation Clinic/Center in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Rehabilitation Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.