Healthcare Provider Details

I. General information

NPI: 1912755794
Provider Name (Legal Business Name): KYLEE ANNE WITHROW OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 S TENNIS LN STE 6
SIOUX FALLS SD
57108-2231
US

IV. Provider business mailing address

5020 S TENNIS LN STE 6
SIOUX FALLS SD
57108-2231
US

V. Phone/Fax

Practice location:
  • Phone: 605-961-7250
  • Fax:
Mailing address:
  • Phone: 605-961-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: