Provider Demographics
NPI:1780276311
Name:SHICK, KYLIE M (COTA)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:M
Last Name:SHICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 RED HILL RD
Mailing Address - Street 2:
Mailing Address - City:DAUPHIN
Mailing Address - State:PA
Mailing Address - Zip Code:17018-9714
Mailing Address - Country:US
Mailing Address - Phone:717-512-5760
Mailing Address - Fax:
Practice Address - Street 1:1324 RED HILL RD
Practice Address - Street 2:
Practice Address - City:DAUPHIN
Practice Address - State:PA
Practice Address - Zip Code:17018-9714
Practice Address - Country:US
Practice Address - Phone:717-512-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist