Healthcare Provider Details

I. General information

NPI: 1174014542
Provider Name (Legal Business Name): KATHERINE E LYLE MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 SR 662 W
NEWBURGH IN
47630
US

IV. Provider business mailing address

2744 N CROSS CREEK DR
EVANSVILLE IN
47715-7731
US

V. Phone/Fax

Practice location:
  • Phone: 812-490-9401
  • Fax: 888-715-3298
Mailing address:
  • Phone: 770-862-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: