Healthcare Provider Details

I. General information

NPI: 1396157079
Provider Name (Legal Business Name): KAYLYNNE JUDITH WILBUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 N LINCOLN ST STE B
SPOKANE WA
99201-2138
US

IV. Provider business mailing address

15312 N SHADY SLOPE RD
SPOKANE WA
99208-8523
US

V. Phone/Fax

Practice location:
  • Phone: 509-655-6330
  • Fax:
Mailing address:
  • Phone: 509-655-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60466271
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: