Provider Demographics
NPI:1336385863
Name:KRABILL, KYLE AUSTIN (C PED)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:AUSTIN
Last Name:KRABILL
Suffix:
Gender:M
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 SHEEPHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:POCOMOKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21851-2307
Mailing Address - Country:US
Mailing Address - Phone:410-726-4637
Mailing Address - Fax:
Practice Address - Street 1:7201 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21850-2039
Practice Address - Country:US
Practice Address - Phone:410-835-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCPED2960225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter