Healthcare Provider Details

I. General information

NPI: 1477470508
Provider Name (Legal Business Name): KEIRA E. M. RAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEIRA E. M. PACANOS

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W BROADWAY STE 700
SALT LAKE CITY UT
84101-2060
US

IV. Provider business mailing address

242 E 880 S
SANTAQUIN UT
84655-5565
US

V. Phone/Fax

Practice location:
  • Phone: 385-462-6756
  • Fax:
Mailing address:
  • Phone: 760-803-3927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-523978
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: