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General NPI Number Information
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NPI Number | 1194483263
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Entity Type | Organization
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Legal Business Name | FOREVER WILD OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 38 TAHOMA RD
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City | SARANAC LAKE
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State | NY
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Zip | 12983-2314
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Country | US
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Telephone | 191-961-6585
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Fax |
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Provider Business Mailing Address
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Address Line | 38 TAHOMA RD
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City | SARANAC LAKE
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State | NY
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Zip | 12983-2314
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Country | US
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Telephone | 191-961-6585
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/OWNER
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Name | ASHLEY GARWOOD
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Credential | OTR/L
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Telephone | 919-616-5850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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