MEDICARE: TYLER FLECK OT

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	1701829	KS

General Provider Information

NPI Number	:	1952427767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER FLECK OT

Provider Business Mailing Address
First Line	:	11623 ARBOR ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-2981
Country	:	US
Telephone Number	:	866-334-1919
Fax Number	:	402-334-6844

Provider Business Practice Location Address
First Line	:	11623 ARBOR ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-2981
Country	:	US
Telephone Number	:	866-334-1919
Fax Number	:	402-334-6844

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	12/26/2017

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