Provider Demographics
NPI:1235723743
Name:FLEMING, KYLE (MT-BC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:FLEMING
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MELROSE DR APT C
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-2016
Mailing Address - Country:US
Mailing Address - Phone:507-360-0909
Mailing Address - Fax:
Practice Address - Street 1:2001 MELROSE DR APT C
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-2016
Practice Address - Country:US
Practice Address - Phone:507-360-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist