Provider Demographics
NPI:1063286797
Name:WALTER, KYLE STEVEN (OTL/L)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:STEVEN
Last Name:WALTER
Suffix:
Gender:M
Credentials:OTL/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:DELANSON
Mailing Address - State:NY
Mailing Address - Zip Code:12053-3117
Mailing Address - Country:US
Mailing Address - Phone:518-344-8883
Mailing Address - Fax:
Practice Address - Street 1:616 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3619
Practice Address - Country:US
Practice Address - Phone:516-586-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028244-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist