Organization
WILDFREE KIDS OT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILLIAN MARIE BLOUNT MOT (OWNER, MOT, OTR/L)
(907) 215-4438
Entity
Organization
Contact information
Practice address
4508 S CARILLON DR, WASILLA, AK 99623-0202
(907) 215-4438
(907) 215-4707
Mailing address
PO BOX 872579, WASILLA, AK 99687-2579
(907) 215-4438
(907) 215-4707
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730280
—
AK
Enumeration date
06/24/2022
Last updated
08/15/2022
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