| Wild Roots Ot Llc | |
|
1057 Old Oliver Rd Walland TN 37886-2338 | |
| (865) 268-9270 | |
| Not Available |
| Full Name | Wild Roots Ot Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 1057 Old Oliver Rd, Walland, Tennessee |
| Authorized Official Name and Position | Nicole Seravello (OWNER) |
| Authorized Official Contact | 2392229911 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Roots Ot Llc 1057 Old Oliver Rd Walland TN 37886-2338 Ph: (239) 222-9911 | Wild Roots Ot Llc 1057 Old Oliver Rd Walland TN 37886-2338 Ph: (865) 268-9270 |
| NPI Number | 1932092178 |
|---|---|
| Provider Enumeration Date | 05/29/2025 |
| Last Update Date | 05/29/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932092178 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |