Healthcare Provider Details

I. General information

NPI: 1508566134
Provider Name (Legal Business Name): KAITLYN MARIE GRUNST MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 E INDIANA AVE STE 5300
SPOKANE VALLEY WA
99216-1882
US

IV. Provider business mailing address

514 S LAWSON ST
AIRWAY HEIGHTS WA
99001-5080
US

V. Phone/Fax

Practice location:
  • Phone: 509-530-5420
  • Fax: 509-891-4088
Mailing address:
  • Phone: 509-560-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61404305
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: