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General NPI Number Information
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NPI Number | 1730978859
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Entity Type | Individual
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Provider Name | KYLIE DISHMAN
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Gender | Female
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 28 JIMMY DOOLITTLE DR
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City | GREENVILLE
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State | SC
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Zip | 29607-2622
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Country | US
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Telephone | 864-679-8606
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 170038
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City | SPARTANBURG
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State | SC
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Zip | 29301-0020
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 7521
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License Number State | SC
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