Healthcare Provider Details

I. General information

NPI: 1821587106
Provider Name (Legal Business Name): KYLIE REZES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3042 MCKINLEY AVE
COLUMBUS OH
43204-3653
US

IV. Provider business mailing address

4301 TAHOE TRL
GROVE CITY OH
43123-8563
US

V. Phone/Fax

Practice location:
  • Phone: 614-487-7805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: