Provider Demographics
NPI:1790383941
Name:SHAMAEV SHIFRIN, KIRA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:SHAMAEV SHIFRIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 TREVINO TER
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-4541
Mailing Address - Country:US
Mailing Address - Phone:847-877-9886
Mailing Address - Fax:
Practice Address - Street 1:1190 OLD MCHENRY RD
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-5088
Practice Address - Country:US
Practice Address - Phone:847-613-4255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist