MEDICARE: KAILEY WEETER OTR

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

General Provider Information

NPI Number	:	1588245203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILEY WEETER OTR

Provider Business Mailing Address
First Line	:	6217 S 74TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-4317
Country	:	US
Telephone Number	:	402-415-6620
Fax Number	:

Provider Business Practice Location Address
First Line	:	9480 S EASTERN AVE STE 273
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8000
Country	:	US
Telephone Number	:	402-415-6620
Fax Number	:

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

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	03/20/2024

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Directions to “ KAILEY WEETER OTR” Practice Location

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