Provider Demographics
NPI:1033097514
Name:LANG, KYLIE (LCAT)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CANASERAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14822-9743
Mailing Address - Country:US
Mailing Address - Phone:240-551-6479
Mailing Address - Fax:
Practice Address - Street 1:1169 PITTSFORD VICTOR RD STE 250
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3809
Practice Address - Country:US
Practice Address - Phone:585-430-9877
Practice Address - Fax:585-200-3215
Is Sole Proprietor?:No
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003171221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist