Provider Demographics
NPI:1750898417
Name:KIRKSEY, KYLIE SHAE
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:SHAE
Last Name:KIRKSEY
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 1:475 MEADOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9425
Mailing Address - Country:US
Mailing Address - Phone:614-572-9909
Mailing Address - Fax:
Practice Address - Street 1:475 MEADOW VIEW DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9425
Practice Address - Country:US
Practice Address - Phone:614-572-9909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11127225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist