MARYKELLY WALLACE MOTR/L
NPI 1598372187
Occupational Therapist in Dearborn, MI
About Marykelly Wallace Motr/l NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MARYKELLY WALLACE MOTR/L (NPI 1598372187) is an individual occupational therapist in Dearborn, Michigan, licensed in Michigan (5201010849) and active in the NPI registry since September 2020.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Marykelly Wallace Motr/l is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Marykelly Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Dearborn, MI 48126
- Reassigned Medicare billing, Michigan enrollment
- 14 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
DEARBORN, MI 48126
DEARBORN, MI 48126
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Marykelly Wallace's NPI number?
The NPI number for Marykelly Wallace is 1598372187. It was assigned to this individual provider in the NPPES registry on September 28, 2020.
Where is Marykelly Wallace located?
Marykelly Wallace practices at 1 Parklane Blvd Ste 200, Dearborn, MI 48126. The listed phone number is (313) 846-2606.
What is Marykelly Wallace's specialty?
The primary specialty registered for this NPI is Occupational Therapist with taxonomy code 225X00000X.
Is Marykelly Wallace enrolled in Medicare?
Yes. Marykelly Wallace is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Marykelly Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Marykelly Wallace reassigns Medicare benefits to Psygenics Inc (Dearborn, MI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Marykelly Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Marykelly Wallace accept?
Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company and Priority Health list Marykelly Wallace as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Marykelly Wallace was last updated on February 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.