Wildfree Kids OT, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

WILDFREE KIDS OT, LLC

Practice address

4508 S Carillon Dr
Wasilla, AK 99623-0202

Phone

(907) 215-4438

Fax

(907) 215-4707

NPI assigned

Jun 24, 2022

Organization subpart

No

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

Authorized official

Name

Jillian Marie Blount, MOTNPI 1235781923

Title

Owner, Mot, Otr/L

Phone

(907) 215-4438

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jillian Marie Blount, MOT

  • Pediatric Occupational Therapist
  • Minnetonka, MN
  • NPI 1235781923
  NPD Authorized official
• Makayla Ryan

  • Pediatric Occupational Therapist
  • Wasilla, AK
  • NPI 1770445108
  NPD
• Jonathon Leigh Dean

  • Occupational Therapist
  • Boulder, CO
  • NPI 1730723347
  NPD (past)
• Jordan Genovese

  • Occupational Therapist
  • Port Orange, FL
  • NPI 1730504747
  NPD (past)
• Danielle Nichole Nelson

  • Physical Therapist
  • Omaha, NE
  • NPI 1902399512
  NPD (past)

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

{
    "created_epoch": "1656028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1760114243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 872579",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996872579",
            "telephone_number": "907-215-4438",
            "fax_number": "907-215-4707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4508 S CARILLON DR",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996230202",
            "telephone_number": "907-215-4438",
            "fax_number": "907-215-4707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDFREE KIDS OT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-24",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "BLOUNT",
        "authorized_official_first_name": "JILLIAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER, MOT, OTR/L",
        "authorized_official_telephone_number": "907-215-4438",
        "authorized_official_credential": "MOT"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730280",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian D Wight, DDS
• Angela Wilbanks, PMHNP-BC
• John J Wilcox, FNP
• Wild and Rooted Wellness
• Wild Iris LLC (Wild Iris Family Medicine and Maternity Care)
• Zoe Wilkens, OTD, OTR/L
• Mallory J Wilkins, MS,CCC-SLP
• Janet Lynn Wilkinson, APNP
• Annie C Willardson
• Debbie Williams

• Occupational Therapist in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Occupational Therapist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; 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.