Wild Roots OT LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

WILD ROOTS OT LLC

Practice address

1057 Old Oliver Rd
Walland, TN 37886-2338

Phone

(865) 268-9270

NPI assigned

May 29, 2025

Organization subpart

No

Name

Nicole Seravello, OTR/LNPI 1326793001

Title

Owner

Phone

(239) 222-9911

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

• Nicole Marie Seravello, OTR/L

  • Occupational Therapist
  • Maryville, TN
  • NPI 1326793001
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 29, 2025.

{
    "created_epoch": "1748476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1932092178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 OLD OLIVER RD",
            "city": "WALLAND",
            "state": "TN",
            "postal_code": "378862338",
            "telephone_number": "239-222-9911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1057 OLD OLIVER RD",
            "city": "WALLAND",
            "state": "TN",
            "postal_code": "378862338",
            "telephone_number": "865-268-9270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD ROOTS OT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-29",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-28",
        "status": "A",
        "authorized_official_last_name": "SERAVELLO",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-222-9911",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blessed Assurance LLC.
• Alice Denise Compton, RN
• David Mark Gilliam, MD

• All providers in Walland, TN
• Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; 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.