Healthcare Provider Details

I. General information

NPI: 1356878383
Provider Name (Legal Business Name): KAITLYN RADI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 01/06/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FRONTIER BEHAVIORAL HEALTH, 5125 N. MARKET ST.
SPOKANE WA
99217
US

IV. Provider business mailing address

FRONTIER BEHAVIORAL HEALTH, 107 S. DIVISION STREET
SPOKANE WA
99202
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-4651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61245406
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTP-OT-LIC-3308
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: