Provider Demographics
NPI:1053869511
Name:SHOEMAKER, KAY EILEEN (PT)
Entity type:Individual
Prefix:MS
First Name:KAY
Middle Name:EILEEN
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KAY
Other - Middle Name:EILEEN
Other - Last Name:SHOEMAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:107 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2337
Mailing Address - Country:US
Mailing Address - Phone:302-478-4544
Mailing Address - Fax:302-478-4544
Practice Address - Street 1:107 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2337
Practice Address - Country:US
Practice Address - Phone:302-478-4544
Practice Address - Fax:302-478-4544
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist