Healthcare Provider Details

I. General information

NPI: 1871456582
Provider Name (Legal Business Name): KALI YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 N 4TH ST STE 104
COEUR D ALENE ID
83814-3100
US

IV. Provider business mailing address

5796 N MORLEAU LN
COEUR D ALENE ID
83815-0424
US

V. Phone/Fax

Practice location:
  • Phone: 208-659-5925
  • Fax:
Mailing address:
  • Phone: 208-659-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAS-4470
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: