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General NPI Number Information
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NPI Number | 1447040076
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Entity Type | Organization
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Legal Business Name | WILDFLOWER PEDIATRIC THERAPY, LLC
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 31 S EAGLE RD STE 203
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City | HAVERTOWN
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State | PA
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Zip | 19083-3340
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Country | US
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Telephone | 614-745-6746
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Fax |
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Provider Business Mailing Address
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Address Line | 3553 WEST CHESTER PIKE PMB 109
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073
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Country | US
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Telephone | 614-745-6746
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | NICOLE WARNECKE
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Credential |
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Telephone | 614-745-6746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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