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NPI Code Detail

MEDICARE: KALEY DRAPER PTA

MEDICARE: KALEY DRAPER PTA
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
1225100000XPhysical Therapist864NE

General Provider Information

NPI Number : 1508017302
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALEY DRAPER PTA
Provider Business Mailing Address
First Line : 11623 ARBOR ST
Second Line :
City : OMAHA
State : NE
Zip : 68144-2981
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 410 W 5TH ST
Second Line :
City : LOUISVILLE
State : NE
Zip : 68037-6006
Country : US
Telephone Number : 402-234-2125
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2008
Last Update Date : 10/10/2008

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Directions to “ KALEY DRAPER PTA” Practice Location

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