| Blossom Children's Center-novi | |
|
44225 W 12 Mile Rd Ste C-106 Novi MI 48377-2640 | |
| (248) 860-6212 | |
| (248) 277-3050 |
| Full Name | Blossom Children's Center-novi |
|---|---|
| Speciality | Behavior Analyst |
| Location | 44225 W 12 Mile Rd Ste C-106, Novi, Michigan |
| Authorized Official Name and Position | Ziad Koza (CEO) |
| Authorized Official Contact | 2488606212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blossom Children's Center-novi 44225 W 12 Mile Rd Ste C-106 Novi MI 48377-2640 Ph: (248) 277-3005 | Blossom Children's Center-novi 44225 W 12 Mile Rd Ste C-106 Novi MI 48377-2640 Ph: (248) 860-6212 |
| NPI Number | 1508329962 |
|---|---|
| Provider Enumeration Date | 04/11/2019 |
| Last Update Date | 11/02/2022 |
| Certification Date | 11/02/2022 |
| Medicare PECOS PAC ID | 0941634216 |
|---|---|
| Medicare Enrollment ID | O20191218003019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508329962 | NPI | - | NPPES |
| Provider Name | Kelly Hamilton |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1427623149 PECOS PAC ID: 7416301130 Enrollment ID: I20230929000768 |
| Provider Name | Riley Grace Dewitt |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1548996374 PECOS PAC ID: 0941658991 Enrollment ID: I20231130003515 |
| Provider Name | Christina Mallory Mcdowell |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1861979221 PECOS PAC ID: 6608219738 Enrollment ID: I20240206002528 |
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