Provider Demographics
NPI:1912509654
Name:SCHUFREIDER, KYLE CHRISTIAN (MS,OTR/L)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:CHRISTIAN
Last Name:SCHUFREIDER
Suffix:
Gender:M
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2450 ATLANTA HWY STE 701
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1255
Mailing Address - Country:US
Mailing Address - Phone:404-834-8404
Mailing Address - Fax:678-456-3437
Practice Address - Street 1:2450 ATLANTA HWY STE 701
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1255
Practice Address - Country:US
Practice Address - Phone:404-834-8404
Practice Address - Fax:678-456-3437
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAOT007905225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics