Kaitlin Jean Wallace

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT-1570 Issued in WY

Practice address

918 W Brundage LN
Sheridan, WY 82801-5827

Phone

(307) 673-4420

NPI assigned

Jul 27, 2021

Last updated

Jul 27, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sensational Kids LLC

  • Pediatric Occupational Therapist
  • Cheyenne, WY
  • NPI 1144605916
  NPD (past)
• Sensational Kids, LLC

  • Pediatric Occupational Therapist
  • Sheridan, WY
  • NPI 1851605604
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1033882956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 N CUSTER ST APT 102",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828013749",
            "telephone_number": "818-209-8709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 W BRUNDAGE LN",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828015827",
            "telephone_number": "307-673-4420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KAITLIN",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-27",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WY",
            "license": "OT-1570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David C Walker, DO
• Lisa Marie Wall, LPN
• Terry L Wall, MA
• Ian Wallace
• Judith Wallace, MAC, LAT
• Juli K Wallin-Fisgus, MSW LCSW
• Sandra Ann Wallop, MS
• Walmart Inc. (Walmart Pharmacy 10-1508)
• Karen Lee Walmsley, MSW
• Alexis N Walter, MSW

• Occupational Therapist in Sheridan, WY
• Providers in Sheridan, WY by specialty
• Occupational Therapist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.