MEDICARE: MAISON MCCULLEY

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1588527576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAISON MCCULLEY

Provider Business Mailing Address
First Line	:	17831 HARNEY ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-3502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15677 SPAULDING ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-8411
Country	:	US
Telephone Number	:	402-614-8202
Fax Number	:	402-614-8202

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

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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Directions to “ MAISON MCCULLEY ” Practice Location

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