Healthcare Provider Details

I. General information

NPI: 1750543377
Provider Name (Legal Business Name): KYLE RICHARD RATERMAN AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E ENON RD
YELLOW SPRINGS OH
45387-1415
US

IV. Provider business mailing address

360 E ENON RD
YELLOW SPRINGS OH
45387-1415
US

V. Phone/Fax

Practice location:
  • Phone: 630-200-9787
  • Fax: 937-767-1025
Mailing address:
  • Phone: 630-200-9787
  • Fax: 937-767-1025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number147.001259
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number147.001259
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number147.001259
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.02061
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: