# WILD: WOMEN AND INFANTS LONG-TERM DEVELOPMENT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689295693
- **Authorized official:** DR. HAYLEY CHRZASTOWSKI OTD, OTR/L (FOUNDER/OWNER)
- **Authorized official phone:** (812) 219-0743

## Contact information

- **Practice address:** 1003 MAHONE ST, FREDERICKSBURG, VA 22401-6214
- **Practice address phone:** (540) 693-0274
- **Mailing address:** 515 WEEDON ST, FREDERICKSBURG, VA 22401-5640
- **Mailing address phone:** (812) 219-0743

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | — |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/30/2020
- **Last updated:** 05/21/2020