Provider Demographics
NPI:1871121442
Name:BURTON-SMILES, KYLEAH RAYNE
Entity type:Individual
Prefix:
First Name:KYLEAH
Middle Name:RAYNE
Last Name:BURTON-SMILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 TOWNSHIP ROAD 129 S
Mailing Address - Street 2:
Mailing Address - City:ZANESFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43360-9755
Mailing Address - Country:US
Mailing Address - Phone:614-578-5030
Mailing Address - Fax:
Practice Address - Street 1:398 S GRANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5549
Practice Address - Country:US
Practice Address - Phone:614-224-2988
Practice Address - Fax:614-716-0902
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator