Healthcare Provider Details

I. General information

NPI: 1790601920
Provider Name (Legal Business Name): WILD LIGHT MASSAGE & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 TONGLEN RD
DENALI PARK AK
99755-0247
US

IV. Provider business mailing address

PO BOX 454
DENALI NATIONAL PARK AK
99755-0454
US

V. Phone/Fax

Practice location:
  • Phone: 207-812-0246
  • Fax:
Mailing address:
  • Phone: 207-812-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: KATE ORLOFSKY
Title or Position: OWNER
Credential: LMT
Phone: 207-812-0246