Healthcare Provider Details

I. General information

NPI: 1760313217
Provider Name (Legal Business Name): KYNSIE MARINE VALDEZ OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 N MAIN ST STE 5
SPEARFISH SD
57783-2436
US

IV. Provider business mailing address

1211 S DOUGLAS HWY STE 100
GILLETTE WY
82716-4982
US

V. Phone/Fax

Practice location:
  • Phone: 605-644-7850
  • Fax:
Mailing address:
  • Phone: 605-644-7850
  • Fax: 605-443-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4307
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-1960
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: