Provider Demographics
NPI:1750543377
Name:RATERMAN, KYLE RICHARD (AUD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:RICHARD
Last Name:RATERMAN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E ENON RD
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1415
Mailing Address - Country:US
Mailing Address - Phone:630-200-9787
Mailing Address - Fax:937-767-1025
Practice Address - Street 1:360 E ENON RD
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1415
Practice Address - Country:US
Practice Address - Phone:630-200-9787
Practice Address - Fax:937-767-1025
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001259231HA2400X, 231HA2500X, 237600000X
OHA.02061231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter