Provider Demographics
NPI:1649635483
Name:SWIM, KYLE (OTR/L)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SWIM
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:MR
Other - First Name:KYLE
Other - Middle Name:TYLER
Other - Last Name:SWIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1058 LIMERICK LN
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4049
Mailing Address - Country:US
Mailing Address - Phone:540-769-9560
Mailing Address - Fax:
Practice Address - Street 1:1058 LIMERICK LN
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4049
Practice Address - Country:US
Practice Address - Phone:540-769-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005185225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist