Provider Demographics
NPI:1073853727
Name:KYLE, MARY KIRSTEN (MT-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KIRSTEN
Last Name:KYLE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:KYLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT-BC
Mailing Address - Street 1:1669 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1669 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1230
Practice Address - Country:US
Practice Address - Phone:248-646-3347
Practice Address - Fax:248-646-4480
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist