MEDICARE: KELLY VAN ERT 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
1	225X00000X	Occupational Therapist	106249	MN
2	225X00000X	Occupational Therapist	1732	NE

General Provider Information

NPI Number	:	1790235943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY VAN ERT OTR/L

Provider Business Mailing Address
First Line	:	4728 S 165TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-1352
Country	:	US
Telephone Number	:	402-739-1981
Fax Number	:

Provider Business Practice Location Address
First Line	:	4728 S 165TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-1352
Country	:	US
Telephone Number	:	402-739-1981
Fax Number	:

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

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	04/10/2026

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Directions to “ KELLY VAN ERT OTR/L” Practice Location

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