Provider Demographics
NPI:1750037966
Name:MCINTOSH, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MCINTOSH
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 1:177 PEPPERRELL RD # 1
Mailing Address - Street 2:
Mailing Address - City:KITTERY POINT
Mailing Address - State:ME
Mailing Address - Zip Code:03905-5114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:177 PEPPERRELL RD # 1
Practice Address - Street 2:
Practice Address - City:KITTERY POINT
Practice Address - State:ME
Practice Address - Zip Code:03905-5114
Practice Address - Country:US
Practice Address - Phone:719-238-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist