Provider Demographics
NPI:1033749684
Name:LYLES, KELSIE LEIGH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KELSIE
Middle Name:LEIGH
Last Name:LYLES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:KELSIE
Other - Middle Name:LEIGH
Other - Last Name:EVOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:669 VASSAR ST APT 633
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6025
Mailing Address - Country:US
Mailing Address - Phone:317-383-1158
Mailing Address - Fax:
Practice Address - Street 1:4500 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-4732
Practice Address - Country:US
Practice Address - Phone:765-641-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006845A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist