Provider Demographics
NPI:1518786334
Name:LEWIS, KYLIE (OT)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:DEBAETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5285
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5285
Mailing Address - Country:US
Mailing Address - Phone:308-675-1853
Mailing Address - Fax:308-210-4121
Practice Address - Street 1:4701 CHAMPLAIN DR STE 500
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4764
Practice Address - Country:US
Practice Address - Phone:402-413-2127
Practice Address - Fax:402-413-2163
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2959225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist