Individual
KYLE JOHN BLIEVERNICHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MOT
Contact information
Practice address
4955 S STATE ROUTE 159 STE B, GLEN CARBON, IL 62034-1907
(618) 288-4677
(618) 288-4699
Mailing address
4955 S STATE ROUTE 159 STE B, GLEN CARBON, IL 62034-1907
(618) 288-4677
(618) 288-4699
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
09/06/2019
Last updated
09/06/2019
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