Healthcare Provider Details

I. General information

NPI: 1962932939
Provider Name (Legal Business Name): STEPHANIE WILD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 GENERATIONS WAY
FRANKLIN TN
37064-1580
US

IV. Provider business mailing address

307 INTERNATIONAL CIR STE 100
HUNT VALLEY MD
21030-1387
US

V. Phone/Fax

Practice location:
  • Phone: 615-614-8555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7130
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT18557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: