Provider Demographics
NPI:1770229379
Name:ARP, KYLIE MEDLIN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:MEDLIN
Last Name:ARP
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 CRANTOCK RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-8293
Mailing Address - Country:US
Mailing Address - Phone:919-723-0952
Mailing Address - Fax:
Practice Address - Street 1:447 VENTURE DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4765
Practice Address - Country:US
Practice Address - Phone:910-298-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14688225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist