Active NPI
Kayle A Wiseman, CTRS
- Recreation Therapist
- Waterloo, NE
National Provider Identifier
1083290126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 81878
- Practice address
- 800 N Front St Ste 15
Waterloo, NE 68069-2250 - Phone
- (402) 669-3197
- NPI assigned
- Mar 19, 2021
- Last updated
- Mar 19, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 81878 | NE | Primary |
Addresses
Primary practice location
800 N Front St Ste 15
Waterloo, NE 68069-2250
Mailing address
800 N Front St Ste 15
Waterloo, NE 68069-2250
Phone (402) 669-3197
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 81878 | NE | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616112000000",
"number": "1083290126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 N FRONT ST STE 15",
"city": "WATERLOO",
"state": "NE",
"postal_code": "680692250",
"telephone_number": "402-669-3197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 N FRONT ST STE 15",
"city": "WATERLOO",
"state": "NE",
"postal_code": "680692250",
"telephone_number": "402-669-3197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISEMAN",
"first_name": "KAYLE",
"middle_name": "A",
"credential": "CTRS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-19",
"last_updated": "2021-03-19",
"certification_date": "2021-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "NE",
"license": "81878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.