Healthcare Provider Details

I. General information

NPI: 1922914415
Provider Name (Legal Business Name): WILDFLOWER WELLNESS THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 BERRY RD
HOWARD OH
43028-9542
US

IV. Provider business mailing address

622 BERRY RD
HOWARD OH
43028-9542
US

V. Phone/Fax

Practice location:
  • Phone: 740-263-7231
  • Fax: 844-870-0403
Mailing address:
  • Phone: 740-263-7231
  • Fax: 844-870-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. STACEY ROSSELOT
Title or Position: MANAGING MEMBER, CFO, COO
Credential: OTD, MOTR/L
Phone: 740-263-7231