MEDICARE: KYLE SELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1134524135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE SELL

Provider Business Mailing Address
First Line	:	6124 CROFTON DR
Second Line	:	KDS HEALTH AND WELLNESS CONSULTING, LLC
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-8708
Country	:	US
Telephone Number	:	260-413-3287
Fax Number	:

Provider Business Practice Location Address
First Line	:	6124 CROFTON DR
Second Line	:	KDS HEALTH AND WELLNESS CONSULTING, LLC
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-8708
Country	:	US
Telephone Number	:	260-413-3287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	11/03/2014

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Directions to “ KYLE SELL ” Practice Location

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