Healthcare Provider Details

I. General information

NPI: 1912772070
Provider Name (Legal Business Name): WILDFLOWER OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4535
US

IV. Provider business mailing address

PO BOX 498
OAKLAND ME
04963-0498
US

V. Phone/Fax

Practice location:
  • Phone: 207-830-0680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: HEATHER HALL
Title or Position: OCCUPATIONAL THERAPIST
Credential: OT
Phone: 631-626-5541