MARYKELLY WALLACE MOTR/L
NPI 1598372187
Occupational Therapist in Dearborn, MI

Active since September 28, 2020
1 PARKLANE BLVD STE 200, DEARBORN, MI 48126(313) 846-2606 Get Directions Write a Review

NPPES record last updated: February 14, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 14, 2025, Sep 28, 2020 (2 updates tracked since 2020).

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

NPI1598372187
Entity TypeIndividualFemale
Primary Taxonomy225X00000X
Provider Legal NameMARYKELLY WALLACECredential: MOTR/L
Location Address1 PARKLANE BLVD STE 200Dearborn, MI 48126-4221
Mailing Address27085 Gratiot Ave Ste 101Roseville, MI 48066-2984
Sole ProprietorNo
Enumeration DateSeptember 28, 2020
Last NPPES UpdateFebruary 14, 20252 updates tracked since enumeration
NPPES CertifiedFebruary 14, 2025
✔ NPI 1598372187 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOccupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225X00000X
License✔ Licensed in MI · 5201010849
Definition
An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork experience required by the occupational therapy program; has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life.
1 PARKLANE BLVD STE 200, Dearborn, MI 48126

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.

Same address
Clinical
1 PARKLANE BLVD STE 200E
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.

Speech-Language Pathologist
1 PARKLANE BLVD STE 200
DEARBORN, MI 48126
Nurse Practitioner (Psychiatric/Mental Health)
1 PARKLANE BLVD STE 200
DEARBORN, MI 48126
Social Worker
1 PARKLANE BLVD STE 200
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.