Healthcare Provider Details

I. General information

NPI: 1396937108
Provider Name (Legal Business Name): KELLY LYNN LITTLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 1ST ST
MILFORD NE
68405-9708
US

IV. Provider business mailing address

340 WALNUT ST. P.O. BOX 238
HALLAM NE
68368
US

V. Phone/Fax

Practice location:
  • Phone: 402-761-2261
  • Fax:
Mailing address:
  • Phone: 402-230-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number897
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: