Healthcare Provider Details

I. General information

NPI: 1659947653
Provider Name (Legal Business Name): KAELA NICOLE SPINKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 GEORGIA ST
VALLEJO CA
94590-6005
US

IV. Provider business mailing address

444 GEORGIA ST
VALLEJO CA
94590-6005
US

V. Phone/Fax

Practice location:
  • Phone: 209-203-2460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: