Provider Demographics
NPI:1346430162
Name:KYLE, VICTORIA (OT)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:KYLE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LACRUE ST.
Mailing Address - Street 2:STE 210
Mailing Address - City:CONCORDVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19331
Mailing Address - Country:US
Mailing Address - Phone:800-578-7906
Mailing Address - Fax:
Practice Address - Street 1:9 LACRUE ST.
Practice Address - Street 2:STE 210
Practice Address - City:CONCORDVILLE
Practice Address - State:PA
Practice Address - Zip Code:19331
Practice Address - Country:US
Practice Address - Phone:800-578-7906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004534225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist