Organization
WILD ROOTS OT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE SERAVELLO OTR/L (OWNER)
(239) 222-9911
Entity
Organization
Contact information
Practice address
1057 OLD OLIVER RD, WALLAND, TN 37886-2338
(865) 268-9270
Mailing address
1057 OLD OLIVER RD, WALLAND, TN 37886-2338
(239) 222-9911
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
05/29/2025
Last updated
05/29/2025
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