Provider Demographics
NPI:1396080859
Name:WELTON, KYLE E (BC-HIS,ACA)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:E
Last Name:WELTON
Suffix:
Gender:M
Credentials:BC-HIS,ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 SW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4767
Mailing Address - Country:US
Mailing Address - Phone:848-525-6162
Mailing Address - Fax:
Practice Address - Street 1:1995 W NASA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-2300
Practice Address - Country:US
Practice Address - Phone:321-608-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4749237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist