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NPI Code Detail

MEDICARE: KELLY LYNN LITTLE OTR/L

MEDICARE: KELLY LYNN LITTLE OTR/L
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
1225X00000XOccupational Therapist897NE

General Provider Information

NPI Number : 1396937108
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY LYNN LITTLE OTR/L
Provider Business Mailing Address
First Line : 340 WALNUT ST.
Second Line : P.O. BOX 238
City : HALLAM
State : NE
Zip : 68368
Country : US
Telephone Number : 402-230-0194
Fax Number :
Provider Business Practice Location Address
First Line : 1100 1ST ST
Second Line :
City : MILFORD
State : NE
Zip : 68405-9708
Country : US
Telephone Number : 402-761-2261
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2007
Last Update Date : 08/15/2007

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