Healthcare Provider Details

I. General information

NPI: 1245085596
Provider Name (Legal Business Name): KRISTINA LORRAINE AUSTILL LMT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2024
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 W INDIAN TRAIL RD
SPOKANE WA
99208-4739
US

IV. Provider business mailing address

3754 W INDIAN TRAIL RD
SPOKANE WA
99208-4736
US

V. Phone/Fax

Practice location:
  • Phone: 509-559-3100
  • Fax:
Mailing address:
  • Phone: 509-559-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61618266
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA92972
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: