Marykelly Wallace, MOTR/L
NPI 1598372187ActiveIndividual· Occupational Therapist· Dearborn, MI
Occupational Therapist (MOTR/L) in Dearborn, Michigan, licensed in MI, with an NPI issued in September 2020. Enrolled in Medicare as practitioner - occupational therapist in private practice.
Overview
| NPI | 1598372187 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | MOTR/L |
| Sole proprietor | No |
| NPI issued | Sep 28, 2020 |
| Last updated in NPPES | Feb 14, 2025 |
| Certified by provider | Feb 14, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Occupational Therapist Primary | 225X00000X | 5201010849 | MI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Occupational Therapist in Private Practice (MI) |
|---|
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