Healthcare Provider Details

I. General information

NPI: 1396478186
Provider Name (Legal Business Name): WILDFLOWERS WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ALACO LN
MILFORD NJ
08848-1905
US

IV. Provider business mailing address

2 ALACO LN
MILFORD NJ
08848-1905
US

V. Phone/Fax

Practice location:
  • Phone: 862-268-7372
  • Fax:
Mailing address:
  • Phone: 862-268-7372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE SHEA
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOT, BS OTR/L
Phone: 862-268-7372