Michelle Anne Wildman, OTRL

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

11903 Issued in FL

Practice address

122 Eglin Pkwy NE
Fort Walton Beach, FL 32548-4917

Phone

(850) 543-6227

Fax

(850) 863-9974

NPI assigned

Jan 27, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michelle Wildman, Occupational Therapist, P.a.

  • Developmentally Disabled Services Day Training Agency
  • Fort Walton Beach, FL
  • NPI 1548598204

  Day Training, Developmentally Disabled Services

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003962317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "852 RADFORD CT",
            "city": "SHALIMAR",
            "state": "FL",
            "postal_code": "325792169",
            "telephone_number": "850-543-6227",
            "fax_number": "850-863-9974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 EGLIN PKWY NE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325484917",
            "telephone_number": "850-543-6227",
            "fax_number": "850-863-9974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDMAN",
        "first_name": "MICHELLE",
        "middle_name": "ANNE",
        "credential": "OTRL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "FL",
            "license": "11903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristina Maria White, M.ED; LMFT
• Paulette White
• Robert J White, D.P.M.
• Suzanne White, LCSW
• Kay S Whitten, ARNP
• Christopher T Wiles, DO
• Danieal Lafayette Wilkinson, APRN
• Lilli Katherine Wilkinson
• Sibyl Willauer
• William R Marshall MD PA

• Developmentally Disabled Services Day Training Agency in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Developmentally Disabled Services Day Training Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.