Provider Demographics
NPI:1922562214
Name:RAINBOLT, KAITLYN NICOLE (LMT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:NICOLE
Last Name:RAINBOLT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12905 E SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0731
Mailing Address - Country:US
Mailing Address - Phone:509-922-0303
Mailing Address - Fax:
Practice Address - Street 1:12905 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0731
Practice Address - Country:US
Practice Address - Phone:509-922-0303
Practice Address - Fax:509-922-0657
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60912404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist