Provider Demographics
NPI:1326704933
Name:FLEISCHMANN, KYLIN MARISA (ATP)
Entity Type:Individual
Prefix:
First Name:KYLIN
Middle Name:MARISA
Last Name:FLEISCHMANN
Suffix:
Gender:F
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 SAN LUIS
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-2895
Mailing Address - Country:US
Mailing Address - Phone:303-217-3578
Mailing Address - Fax:
Practice Address - Street 1:16746 FITZHUGH RD STE 103
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5462
Practice Address - Country:US
Practice Address - Phone:512-846-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91807247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX91807OtherATP