Tyler Lee Wallen, OTR/L

Primary specialty

Physical Rehabilitation Occupational TherapistTaxonomy code 225XP0019X

License

31004893A Issued in IN

Practice address

1500 Provident Dr
Warsaw, IN 46580-3297

Phone

(574) 371-2500

NPI assigned

Aug 27, 2010

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1282867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282867200000",
    "number": "1487960456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 BRUBAKER ST",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465802908",
            "telephone_number": "574-453-6544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 PROVIDENT DR",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803297",
            "telephone_number": "574-371-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEN",
        "first_name": "TYLER",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-27",
        "last_updated": "2010-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "IN",
            "license": "31004893A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin D. Waldo Sr., NP
• Alexis Waldron, M.S., CF-SLP
• Walgreen Co (Walgreens #07906)
• Diane E Wallace, MD
• Shane Wallen
• Nicole Danielle Wallick, LSW, LAC
• Sydney Walters
• Nancy J Warren, LMHC
• Warsaw Al, LLC
• Warsaw Community Schools

• Physical Rehabilitation Occupational Therapist in Warsaw, IN
• Providers in Warsaw, IN by specialty
• Physical Rehabilitation Occupational Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; 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.