Provider Demographics
NPI:1508347709
Name:O'TOOLE, KYLE EDWARD (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:EDWARD
Last Name:O'TOOLE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 TOUCHTON RD E APT 607
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4463
Mailing Address - Country:US
Mailing Address - Phone:321-412-5372
Mailing Address - Fax:
Practice Address - Street 1:4435 TOUCHTON RD E APT 607
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-4463
Practice Address - Country:US
Practice Address - Phone:321-412-5372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL49372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer