KYLE SHANE DIETHRICH

TERRE HAUTE, IN
NPI1588962286
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy224Z00000X Occupational Therapy Assistant
(Licence: IN  99045856A)
Enumeration Date2011-03-03
Last Update Date2011-03-03
Business Address
-- KYLE SHANE DIETHRICH COTA
400 COLLEGE AVE.
TERRE HAUTE, IN 47802
Phone number: 812-917-2320
Mailing Address
-- KYLE SHANE DIETHRICH COTA
1402 WATERTREE RD.
TERRE HAUTE, IN 47803
Phone number: 812-870-2416
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