Healthcare Provider Details

I. General information

NPI: 1477457901
Provider Name (Legal Business Name): MADELINE ROSE WILHELM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE ROSE JOHNSON

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 TAYLOR RD STE 200
CHESAPEAKE VA
23321-2452
US

IV. Provider business mailing address

221 E 3RD ST
WAYNESBORO PA
17268-1608
US

V. Phone/Fax

Practice location:
  • Phone: 757-881-1137
  • Fax: 757-881-1137
Mailing address:
  • Phone: 717-446-9587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119011634
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: