Provider Demographics
NPI:1255790150
Name:WELCH, KYLE DAVID
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DAVID
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 RED ROSE TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-8421
Mailing Address - Country:US
Mailing Address - Phone:714-403-9382
Mailing Address - Fax:
Practice Address - Street 1:4524 BOAT CLUB RD STE 180
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-7025
Practice Address - Country:US
Practice Address - Phone:817-764-3825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16020225X00000X
TX122639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist