# EVERWILD THERAPY & WELLNESS

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

## Provider details

- **NPI number:** 1720992076
- **Authorized official:** NICOLE BALISTRERI MS, OT (CO-FOUNDER/OCCUPATIONAL THERAPIST)
- **Authorized official phone:** (262) 208-5087

## Contact information

- **Practice address:** 1896 COUNTY HWY NN, WEST BEND, WI 53095-9712
- **Practice address phone:** (414) 688-8888
- **Mailing address:** 2601 ELKHART DR APT 319, WAUKESHA, WI 53189-8820
- **Mailing address phone:** (262) 208-5087

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/01/2026
- **Last updated:** 10/01/2026