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General NPI Number Information
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NPI Number | 1720992076
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Entity Type | Organization
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Legal Business Name | EVERWILD THERAPY & WELLNESS
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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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 | 2601 ELKHART DR APT 319
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City | WAUKESHA
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State | WI
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Zip | 53189-8820
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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-FOUNDER/OCCUPATIONAL THERAPIST
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Name | NICOLE BALISTRERI
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Credential | MS, OT
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | NULL
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