Healthcare Provider Details

I. General information

NPI: 1114863446
Provider Name (Legal Business Name): OCTOBER SWAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 E INDIANA AVE STE 3400
SPOKANE VALLEY WA
99216-2830
US

IV. Provider business mailing address

3010 S PINES RD APT 49
SPOKANE VALLEY WA
99206-5773
US

V. Phone/Fax

Practice location:
  • Phone: 509-900-3669
  • Fax:
Mailing address:
  • Phone: 509-505-9614
  • Fax: 509-960-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCBT.CB.70115259
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: