Provider Demographics
NPI:1417828500
Name:SHIRAR, KILEY
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:SHIRAR
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 1:10519 E COUNTY ROAD 400 N
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:IN
Mailing Address - Zip Code:46039-9507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5209
Practice Address - Country:US
Practice Address - Phone:765-423-7988
Practice Address - Fax:844-689-1205
Is Sole Proprietor?:No
Enumeration Date:2025-09-13
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist