Provider Demographics
NPI:1851191191
Name:MCCOMAS, KYLIE AMBER RAY (OTR/L)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:AMBER RAY
Last Name:MCCOMAS
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:AMBER
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4775 WOLFORD RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-8468
Mailing Address - Country:US
Mailing Address - Phone:586-258-6357
Mailing Address - Fax:
Practice Address - Street 1:300 ASTORIA RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-1712
Practice Address - Country:US
Practice Address - Phone:937-855-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT013217225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist