Active NPI
Kellie Colleen Costello, MOTRL
- Pediatric Occupational Therapist
- Papillion, NE
National Provider Identifier
1770613275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 1405
- Practice address
- 10601 S 72ND St Ste 103
Papillion, NE 68046-3408 - Phone
- (402) 932-2782
- Fax
- (402) 932-2705
- NPI assigned
- Mar 6, 2007
- Last updated
- Jan 18, 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 1405 | NE | Primary |
Addresses
Primary practice location
10601 S 72ND St Ste 103
Papillion, NE 68046-3408
Mailing address
10791 S 72ND St
Suite 103
Papillion, NE 68046-3423
Phone (402) 932-2782
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31535024 | Other | MO | BLUE CROSS BLUE SHIELD |
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 |
|---|---|---|---|
| 1405 | NE | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Therapy Center | Pediatrics | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610928000000",
"number": "1770613275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10791 S 72ND ST",
"address_2": "SUITE 103",
"city": "PAPILLION",
"state": "NE",
"postal_code": "680463423",
"telephone_number": "402-932-2782",
"fax_number": "402-932-2705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10601 S 72ND ST STE 103",
"city": "PAPILLION",
"state": "NE",
"postal_code": "680463408",
"telephone_number": "402-932-2782",
"fax_number": "402-932-2705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTELLO",
"first_name": "KELLIE",
"middle_name": "COLLEEN",
"name_prefix": "Ms.",
"credential": "MOTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-06",
"last_updated": "2021-01-18",
"certification_date": "2021-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "NE",
"license": "1405",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "31535024",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Papillion, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.