Healthcare Provider Details

I. General information

NPI: 1730090853
Provider Name (Legal Business Name): MAXWELL STEVEN LYLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 W WESTERN AVE
AVONDALE AZ
85323-1848
US

IV. Provider business mailing address

6851 N 93RD AVE APT 3096
GLENDALE AZ
85305-3241
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-010471
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: