Wildworks Therapy, PLLC

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

Legal business name

WILDWORKS THERAPY, PLLC

Practice address

123 Mt Hope Ave
Bangor, ME 04401

Phone

(207) 352-4000

Fax

(207) 808-7259

NPI assigned

Jul 22, 2019

Organization subpart

No

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

Authorized official

Name

Courtney G St Germain, OTR/LNPI 1194073064

Title

Owner/Occupational Therapist

Phone

(207) 352-4000

Specialties & licenses 1

Addresses

Other names 1

• Old Salt Pediatric Therapy, PLLC Former legal business name

Locations

Practitioners 1

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

• Courtney St Germain

  • Mental Health Occupational Therapist
  • Oakland, NJ
  • NPI 1194073064
  NPD Authorized official

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563753600000",
    "number": "1942853635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 PARKWAY S",
            "address_2": "PO BOX 3461",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "04412",
            "telephone_number": "207-352-4000",
            "fax_number": "207-808-7259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 MT HOPE AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "04401",
            "telephone_number": "207-352-4000",
            "fax_number": "207-808-7259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDWORKS THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-22",
        "last_updated": "2019-07-22",
        "status": "A",
        "authorized_official_last_name": "ST GERMAIN",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER/OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "207-352-4000",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Salt Pediatric Therapy, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Garth Allen Wilbanks, MD
• Adam Wilcox
• Tori-Lynn Wilcox, LCSW
• Chrysalis Wild
• Finn Wilder, FNP-BC
• Laura D. Wiley, LCSW
• Marcus Allen Wilkerson, D.D.S.
• Delany B Wilkes, DPT
• Janet R Wilks, SLP
• Celia Willard, MD

• Pediatric Occupational Therapist in Bangor, ME
• Providers in Bangor, ME by specialty
• Pediatric Occupational Therapist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; 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.