Healthcare Provider Details

I. General information

NPI: 1154904860
Provider Name (Legal Business Name): REESE LYTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7016 CORPORATE WAY
WASHINGTON TOWNSHIP OH
45459-4300
US

IV. Provider business mailing address

1301 N HIGH ST
COLUMBUS OH
43201-2460
US

V. Phone/Fax

Practice location:
  • Phone: 937-951-2084
  • Fax: 877-739-5359
Mailing address:
  • Phone: 614-299-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-180803
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: