Provider Demographics
NPI:1346617164
Name:PETTIT, KARA (MS OTR/L)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:PETTIT
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S 19TH ST
Mailing Address - Street 2:APT 813
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1337
Mailing Address - Country:US
Mailing Address - Phone:309-333-2901
Mailing Address - Fax:
Practice Address - Street 1:8031 W CENTER RD
Practice Address - Street 2:SUITE 225
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3158
Practice Address - Country:US
Practice Address - Phone:402-391-5002
Practice Address - Fax:800-278-5002
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004247225X00000X
NE1892225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist