Provider Demographics
NPI:1992693071
Name:SHOEMAKER, KILEY
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:SHOEMAKER
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 1:22387 22 MILE RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:MI
Mailing Address - Zip Code:49338-9722
Mailing Address - Country:US
Mailing Address - Phone:231-250-3572
Mailing Address - Fax:
Practice Address - Street 1:201 TERI DEE UNIT C
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8318
Practice Address - Country:US
Practice Address - Phone:231-268-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician