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

Last updated

May 29, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nicole Seravello, OTR/LNPI 1326793001

Title

Owner

Phone

(239) 222-9911

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• 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.

{
    "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

• Clinic/Center in Walland, TN
• Providers in Walland, TN by specialty
• 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.