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General NPI Number Information
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NPI Number | 1386555712
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Entity Type | Individual
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Provider Name | KAILEY AMBER SHEA DPT
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Gender | Female
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Dates
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Enumeration Date | 09/15/2026
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Last Update Date | 09/15/2026
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Provider Practice Location Address
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Address Line | 2320 E LINCOLN HWY
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City | NEW LENOX
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State | IL
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Zip | 60451-9533
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Country | US
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Telephone | 815-469-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 9500 BORMET DR STE 304
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City | MOKENA
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State | IL
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Zip | 60448-8399
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Country | US
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Telephone | 815-469-1500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 070.040914
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License Number State | IL
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