Provider Demographics
NPI:1265112767
Name:DELOTELL, KYLE DEE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DEE
Last Name:DELOTELL
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 1:1241 HOGAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-6423
Mailing Address - Country:US
Mailing Address - Phone:740-876-2362
Mailing Address - Fax:
Practice Address - Street 1:8843 STATE ROUTE 335
Practice Address - Street 2:
Practice Address - City:MINFORD
Practice Address - State:OH
Practice Address - Zip Code:45653-8669
Practice Address - Country:US
Practice Address - Phone:419-310-7036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker