Provider Demographics
NPI:1265831374
Name:SPIRO, KELLEY JEAN
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:JEAN
Last Name:SPIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:JEAN
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5730 BREEZELAND RD
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-3347
Mailing Address - Country:US
Mailing Address - Phone:847-836-8167
Mailing Address - Fax:
Practice Address - Street 1:5730 BREEZELAND RD
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110
Practice Address - Country:US
Practice Address - Phone:847-836-8167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist