Provider Demographics
NPI:1851055701
Name:STAMP, MAKAYLA (MOT)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:
Last Name:STAMP
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E 56TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8628
Mailing Address - Country:US
Mailing Address - Phone:308-233-5060
Mailing Address - Fax:308-233-5062
Practice Address - Street 1:920 E 56TH ST STE A
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8628
Practice Address - Country:US
Practice Address - Phone:308-233-5060
Practice Address - Fax:308-233-5062
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2628225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2628OtherOT LICENSE