=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649898883
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WISE OWL PEDIATRIC THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2020
-----------------------------------------------------
Last Update Date | 09/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5314 W FRIENDLY AVE STE E
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27410-4351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-285-7324
-----------------------------------------------------
Fax | 336-579-0693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5314 W FRIENDLY AVE STE E
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27410-4351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-285-7324
-----------------------------------------------------
Fax | 336-579-0693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | KAYLA NICOLE PERKINSON
-----------------------------------------------------
Credential | MS, OTR/L
-----------------------------------------------------
Telephone | 336-522-9886
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XF0002X
-----------------------------------------------------
Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------