Provider Demographics
NPI:1497406524
Name:PECHTOLD, KYLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:PECHTOLD
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 PIAZZA DR APT 210
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-8135
Mailing Address - Country:US
Mailing Address - Phone:814-441-8111
Mailing Address - Fax:
Practice Address - Street 1:3745 PIAZZA DR APT 210
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-8135
Practice Address - Country:US
Practice Address - Phone:814-441-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL420414224Z00000X
FL17247224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant