Healthcare Provider Details

I. General information

NPI: 1023253440
Provider Name (Legal Business Name): WILDWOOD OCCUPATIONAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 WINKLERS CREEK RD UNIT B
BOONE NC
28607-7838
US

IV. Provider business mailing address

PO BOX 2496
BOONE NC
28607-2496
US

V. Phone/Fax

Practice location:
  • Phone: 828-773-8477
  • Fax: 877-384-7096
Mailing address:
  • Phone: 828-773-8477
  • Fax: 828-297-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NATALIE COOKE COOPER
Title or Position: OT/L, DIRECTOR
Credential: OT/L
Phone: 828-773-8477