Healthcare Provider Details

I. General information

NPI: 1417828500
Provider Name (Legal Business Name): KILEY SHIRAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROFESSIONAL CT
LAFAYETTE IN
47905-5209
US

IV. Provider business mailing address

10519 E COUNTY ROAD 400 N
FOREST IN
46039-9507
US

V. Phone/Fax

Practice location:
  • Phone: 765-423-7988
  • Fax: 844-689-1205
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: