Provider Demographics
NPI:1447040076
Name:WILDFLOWER PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:WILDFLOWER PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNECKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-745-6746
Mailing Address - Street 1:3553 WEST CHESTER PIKE
Mailing Address - Street 2:PMB 109
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073
Mailing Address - Country:US
Mailing Address - Phone:614-745-6746
Mailing Address - Fax:
Practice Address - Street 1:31 S EAGLE RD STE 203
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3340
Practice Address - Country:US
Practice Address - Phone:614-745-6746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty