MEDICARE: TAYLOR A PETITT OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist		IL

General Provider Information

NPI Number	:	1184291676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR A PETITT OT

Provider Business Mailing Address
First Line	:	PO BOX 34669
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-0669
Country	:	US
Telephone Number	:	402-932-6791
Fax Number	:	26-147-8354

Provider Business Practice Location Address
First Line	:	2436 N 48TH ST STE 101
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68504-3627
Country	:	US
Telephone Number	:	23-256-3414
Fax Number	:	402-488-0056

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	01/03/2025

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Directions to “ TAYLOR A PETITT OT” Practice Location

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