MEDICARE: WILDFLOWER PEDIATRIC THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1447040076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILDFLOWER PEDIATRIC THERAPY, LLC

Provider Business Mailing Address
First Line	:	3553 WEST CHESTER PIKE
Second Line	:	PMB 109
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073
Country	:	US
Telephone Number	:	614-745-6746
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 S EAGLE RD STE 203
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-3340
Country	:	US
Telephone Number	:	614-745-6746
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	NICOLE WARNECKE
Credential	:
Telephone Number	:	614-745-6746

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	05/07/2025

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