Provider Demographics
NPI:1134725518
Name:KILROY, KAITLIN SHOEMAKER
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:SHOEMAKER
Last Name:KILROY
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 1:2797 TONAWANDA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1430
Mailing Address - Country:US
Mailing Address - Phone:716-307-4028
Mailing Address - Fax:
Practice Address - Street 1:7264 NASH RD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1508
Practice Address - Country:US
Practice Address - Phone:716-694-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016918-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist