Provider Demographics
NPI:1174358022
Name:DICK, KYLE WILLIAM (OTR/L)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:WILLIAM
Last Name:DICK
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14428-9607
Mailing Address - Country:US
Mailing Address - Phone:585-831-2427
Mailing Address - Fax:
Practice Address - Street 1:125 ROCKEFELLER RD
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-2221
Practice Address - Country:US
Practice Address - Phone:518-439-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health