Active NPI
Jason Wildeman, OTR/L
- Occupational Therapist
- Bentonville, AR
National Provider Identifier
1396701520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTR 1463
- Practice address
- 3351 SW 4TH St
Bentonville, AR 72712-9137 - Phone
- (479) 936-6265
- NPI assigned
- Apr 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTR 1463 | AR | Primary |
Addresses
Primary practice location
3351 SW 4TH St
Bentonville, AR 72712-9137
Mailing address
3351 SW 4TH St
Bentonville, AR 72712-9137
Phone (479) 936-6265
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5W780 | Other | AR | BLUECROSS BLUESHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTR 1463 | AR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1396701520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3351 SW 4TH ST",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727129137",
"telephone_number": "479-936-6265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3351 SW 4TH ST",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727129137",
"telephone_number": "479-936-6265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDEMAN",
"first_name": "JASON",
"name_prefix": "Mr.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-25",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AR",
"license": "OTR 1463",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD",
"identifier": "5W780",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bentonville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.