Healthcare Provider Details

I. General information

NPI: 1811837073
Provider Name (Legal Business Name): WILDFLOWER PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 BLAIR CIR
PEA RIDGE AR
72751-3182
US

IV. Provider business mailing address

203 BLAIR CIR
PEA RIDGE AR
72751-3182
US

V. Phone/Fax

Practice location:
  • Phone: 662-322-3187
  • Fax: 662-322-3187
Mailing address:
  • Phone: 662-322-3187
  • Fax: 662-322-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KACIE WHITE
Title or Position: OWNER/ OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 662-322-3187