Healthcare Provider Details

I. General information

NPI: 1780592808
Provider Name (Legal Business Name): CASEY MIRACLE RAIMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13701 E SPRAGUE AVE
SPOKANE VALLEY WA
99216-0811
US

IV. Provider business mailing address

13701 E SPRAGUE AVE
SPOKANE VALLEY WA
99216-0811
US

V. Phone/Fax

Practice location:
  • Phone: 509-590-0156
  • Fax:
Mailing address:
  • Phone: 509-590-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70160921
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: