Active NPI
Kaylee Wallace, OTR/L, CLT
- Occupational Therapist
- Omaha, NE
National Provider Identifier
1225402159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1944
- Practice address
- 17500 Burke St
Omaha, NE 68118-2244 - Phone
- (402) 401-3654
- NPI assigned
- Nov 16, 2015
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1944 | NE | Primary |
Addresses
Primary practice location
17500 Burke St
Omaha, NE 68118-2244
Mailing address
5401 South St
Lincoln, NE 68506-2150
Phone (402) 413-3900
Other practice location 1
13336 Industrial Rd
Suite 105
Omaha, NE 68137-1124
Phone (402) 330-3211 ext. 119
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47065477702 | Medicaid | NE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1944 | NE | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Makovicka Harms Group PC | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685404800000",
"number": "1225402159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5401 SOUTH ST",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685062150",
"telephone_number": "402-413-3900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17500 BURKE ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681182244",
"telephone_number": "402-401-3654"
}
],
"practiceLocations": [
{
"address_1": "13336 Industrial Rd",
"address_2": "Suite 105",
"address_purpose": "LOCATION",
"city": "Omaha",
"state": "NE",
"postal_code": "681371124",
"country_code": "US",
"telephone_number": "402-330-3211 x119",
"fax_number": "402-330-5970",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLACE",
"first_name": "KAYLEE",
"credential": "OTR/L, CLT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-11-16",
"last_updated": "2023-05-30",
"certification_date": "2023-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NE",
"license": "1944",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47065477702",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.