Individual
MS. KELLIE COLLEEN COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTRL
Contact information
Practice address
10601 S 72ND ST STE 103, PAPILLION, NE 68046-3408
(402) 932-2782
(402) 932-2705
Mailing address
10791 S 72ND ST, SUITE 103, PAPILLION, NE 68046-3423
(402) 932-2782
(402) 932-2705
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1405
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31535024
BLUE CROSS BLUE SHIELD
MO
Enumeration date
03/06/2007
Last updated
01/18/2021
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