Individual
KYLE ALCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9434 LIMA RD STE C, FORT WAYNE, IN 46818-8934
(260) 492-9334
Mailing address
9434 LIMA RD STE C, FORT WAYNE, IN 46818-8934
(260) 492-9334
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
07/11/2018
Last updated
06/11/2019
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