MARYKELLY WALLACE (NPI# 1598372187) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598372187 |
| Entity Type | Individual |
| Full Name | MARYKELLY WALLACE |
| Credential | MOTR/L |
| Practice Address |
7800 W Outer Dr Ste 300 Detroit MI 48235-3458 |
| Mailing Address |
27085 Gratiot Ave Ste 101 Roseville MI 48066-2984 |
| Practice Telephone | 5862045560 |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2020-09-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225X00000X | Occupational Therapist | 5201010849 | MI | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
7800 W OUTER DR STE 300 |
| City | DETROIT |
| State | MI |
| Zip Code | 48235-3458 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629233952 | Sandra Duque | Social Worker | 7800 W Outer Dr Ste 300, Detroit, MI 48235-3458 | 2008-07-25 |
| 1124633003 | Shannon Jessica Jason | Case Manager/Care Coordinator | 7800 W Outer Dr Ste 300, Detroit, MI 48235-3458 | 2020-09-09 |
| 1518577121 | Sarah Downey | Occupational Therapist | 7800 W Outer Dr Ste 300, Detroit, MI 48235-3458 | 2020-08-07 |
| 1548878408 | Andrea Lynne Schmitt | Speech-Language Pathologist | 7800 W Outer Dr Ste 300, Detroit, MI 48235-3458 | 2020-07-16 |
| 1124646310 | Torey M. Mcnally | Speech-Language Pathologist | 7800 W Outer Dr Ste 300, Detroit, MI 48235-3458 | 2020-07-14 |
| 1205468006 | Jacob C Clark | Occupational Therapy Assistant | 7800 W Outer Dr Ste 300, Detroit, MI 48235-3458 | 2020-02-10 |
| 1750912416 | Janice Nicole Tillmon | Social Worker | 7800 W Outer Dr Ste 300, Detroit, MI 48235-3458 | 2020-01-31 |
| 1104469303 | Sherisa Renell Mcdonald | Psychologist | 7800 W Outer Dr Ste 300, Detroit, MI 48235-3458 | 2019-10-21 |
| 1558915744 | William Newman | Contractor | 7800 W Outer Dr Ste 300, Detroit, MI 48235-3458 | 2019-07-26 |
| 1386203552 | Lewis Anthony Stonewall | Community Health Worker | 7800 W Outer Dr Ste 300, Detroit, MI 48235-3458 | 2019-06-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457976292 | Ali Nauman Khan | Student in an Organized Health Care Education/Training Program | Detroit Medical Center-sinai Grace Hospital, 6071 W. Outer Driver, Detroit, MI 48235 | 2020-06-08 |
| 1629690565 | Faseeha Arshad Gondal | Student in an Organized Health Care Education/Training Program | Detroit Medical Center Sinai Grace Hospital, 6071 Outer Dr W. Detroit, Mi 48235, United States, Detroit, MI 48235 | 2020-05-14 |
| 1902428832 | Muhanad Abou Touk | Student in an Organized Health Care Education/Training Program | Dmc - Sinai Grace Hospital, Department of Internal Medi, 6071, W. Outer Drive, Detroit, MI 48235 | 2020-05-14 |
| 1780206730 | Ahmad Mismar | Student in an Organized Health Care Education/Training Program | Detroit Medical Center - Sinai Grace Hospital, Departme, 6071 West Outer Drive, Detroit, MI 48235 | 2020-05-13 |
| 1023630589 | Joao Paulo Fontana Bragagnollo | Student in an Organized Health Care Education/Training Program | 6071 W Outer Drive-sinai Grace Hospital, Department of Medicine 4th Floor M-406, Detroit, MI 48235 | 2020-05-07 |
| 1881216216 | Mohammad Awad Jaber | Student in an Organized Health Care Education/Training Program | 6071 W. Outer Drive, Dmc Sinai-grace Hospital, Detroit, MI 48235 | 2020-05-07 |
| 1366064818 | Syeda Busmah Owais | Student in an Organized Health Care Education/Training Program | 6071 Outer Drive, Sinai Grace Hospital, Department of I, Detroit, MI 48235 | 2020-05-07 |
| 1184245680 | Sushmitha Nanja Reddy | Student in an Organized Health Care Education/Training Program | Detroit Medcen Sinai Grace Hospital Dpt of Internal Med, 6071 W Outer Drive, Detroit, MI 48235 | 2020-05-06 |
| 1972164796 | Jack Phillip Tomen | Student in an Organized Health Care Education/Training Program | Sinai - Grace Hospital, 6071 Outer Drive W, Department of Medicine - 4 Main, Detroit, MI 48235 | 2019-06-24 |
| 1346809464 | Anusha Bapatla | Student in an Organized Health Care Education/Training Program | 4 Main, 6071 West Outer Drive, Sinai-grace Hospital, Department of Internal Medicine, Detroit, MI 48235 | 2019-06-12 |
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| Taxonomy Code | 225X00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Occupational Therapist |
| An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork experience required by the occupational therapy program; has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life. |
| Notes: Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: definition changed, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033733928 | Taleshia Moss | Occupational Therapist | 2295 Chene, Detroit, MI 48207 | 2020-06-05 |
| 1013499631 | Cynthia Turner Flanary | Occupational Therapist | 550 County Road 2364, Detroit, TX 75436-3105 | 2018-08-30 |
| 1154801603 | Alicia Jones | Occupational Therapist | 17430 Moran St, Detroit, MI 48212-1168 | 2018-08-15 |
| 1316430374 | Usha Kiran Maddukuri | Occupational Therapist | 3990 John R St # 6930, Detroit, MI 48201-2018 | 2018-06-13 |
| 1568964740 | Renee C Hogan | Occupational Therapist | 2799 W Grand Blvd Bsmt Rehab, Detroit, MI 48202-2608 | 2018-03-05 |
| 1710408190 | Gladys Donaldson | Occupational Therapist | 882 Oakman Blvd Ste E, Detroit, MI 48238-4019 | 2017-07-06 |
| 1487043352 | Dennise A. Johnson | Occupational Therapist | 16101 Archdale St, Detroit, MI 48235-3414 | 2015-01-15 |
| 1245571926 | Amanda Christine Terlikowski | Occupational Therapist | 6376 Vaughan, Detroit, MI 48228-3978 | 2013-03-06 |
| 1669736104 | Psygenics Inc | Occupational Therapist | 7800 W Outer Dr Fl 3, Detroit, MI 48235-3461 | 2012-06-29 |
| 1174801310 | Webster Therapy Services LLC | Occupational Therapist | 8617 Esper St, Detroit, MI 48204-3182 | 2011-07-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.