Healthcare Provider Details

I. General information

NPI: 1861307779
Provider Name (Legal Business Name): KYLEE GRACE BETTINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W MAIN ST
COLDWATER OH
45828-1613
US

IV. Provider business mailing address

3276 STATE ROUTE 219
COLDWATER OH
45828-9721
US

V. Phone/Fax

Practice location:
  • Phone: 418-678-5125
  • Fax:
Mailing address:
  • Phone: 419-910-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number013028
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: