Desiree Wildeman, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

1221 Issued in ND

Practice address

3060 Frontier Way
Fargo, ND 58104-8909

Phone

(701) 232-2340

Fax

(701) 232-2330

NPI assigned

Mar 8, 2012

Sex

Female

Sole proprietor

No

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

Enrolled in ND, MN2 enrollments

Enrollment records 2

Specialty

Occupational Therapist in Private Practice

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopedic and Sports Physical Therapy, IncGroup PAC ID 7416901921, shared by 2 NPIs, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Orthopedic & Sports Physical Therapy Inc.

  • Physical Therapist
  • Hankinson, ND
  • NPI 1225215338
  Medicare reassignment NPD
• Orthopedic & Sports Physical Therapy, Inc

  • Multi-Specialty Clinic/Center
  • Breckenridge, MN
  • NPI 1811923535
  Medicare reassignment NPD
• Orthopedic & Sports Physical Therapy, Inc.

  • Multi-Specialty Clinic/Center
  • Fergus Falls, MN
  • NPI 1992224331
  NPD

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

{
    "created_epoch": "1331164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331164800000",
    "number": "1205100203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3060 FRONTIER WAY",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048909",
            "telephone_number": "701-232-2340",
            "fax_number": "701-232-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3060 FRONTIER WAY",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048909",
            "telephone_number": "701-232-2340",
            "fax_number": "701-232-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDEMAN",
        "first_name": "DESIREE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-08",
        "last_updated": "2012-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "ND",
            "license": "1221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Mark Wiisanen, MD
• Ronald E Wiisanen, MD
• Madisen Jean Wilander, MS,CCC-SLP
• Mackenzie Wild, MD
• Tobias Allen Wilde Sr., MSW, LICSW
• Benjiman Wilebski, MD,ATC
• Ross M Wilhelm, PHARMD
• Ashley Wilke, MD
• Joshua Wilke, MD
• Kelsey Wilker

• Pediatric Occupational Therapist in Fargo, ND
• Providers in Fargo, ND by specialty
• Pediatric Occupational Therapist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.