Healthcare Provider Details

I. General information

NPI: 1336385863
Provider Name (Legal Business Name): KYLE AUSTIN KRABILL C. PED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 FRIENDSHIP RD
PITTSVILLE MD
21850-2039
US

IV. Provider business mailing address

3609 SHEEPHOUSE RD
POCOMOKE CITY MD
21851-2307
US

V. Phone/Fax

Practice location:
  • Phone: 410-835-3668
  • Fax:
Mailing address:
  • Phone: 410-726-4637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCPED2960
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: