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General NPI Number Information
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NPI Number | 1164384228
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Entity Type | Organization
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Legal Business Name | EVERWILD
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Dates
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Enumeration Date | 11/26/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 1896 COUNTY HWY NN
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City | WEST BEND
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State | WI
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Zip | 53095-9712
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Country | US
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Telephone | 414-688-8888
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Fax |
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Provider Business Mailing Address
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Address Line | W169N11054 ASHBURY LN UNIT 2
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City | GERMANTOWN
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State | WI
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Zip | 53022-5570
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Country | US
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Telephone | 262-208-5087
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | AMBER JOY
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Credential | CTRS, CTRI
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Telephone | 262-208-5087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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