Individual
KAYLEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, CLT
Contact information
Practice address
17500 BURKE ST, OMAHA, NE 68118-2244
(402) 401-3654
Mailing address
5401 SOUTH ST, LINCOLN, NE 68506-2150
(402) 413-3900
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1944
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47065477702
—
NE
Enumeration date
11/16/2015
Last updated
05/30/2023
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