Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Kylie Wallace

Individual provider Occupational Therapist · NPI 1902716814

Kylie Wallace is an Occupational Therapist in Shawano, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2026.

Licensed in
WI
In the registry since
2026

Practice location Address checks out

100 County Road B
Shawano, WI 54166-7072
Phone: (715) 526-2111
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence 9268 (WI)

Record details

NPI number1902716814
Entity typeIndividual (Type 1)
GenderNot disclosed
Sole proprietorNo
NPI enumeratedSeptember 11, 2026
Last updated in NPPESSeptember 24, 2026
Certification dateSeptember 24, 2026

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