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General NPI Number Information
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NPI Number | 1811555048
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Entity Type | Individual
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Provider Name | KAITLYN SUE SPALDING
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Gender | Female
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 801 POLE LINE RD W
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City | TWIN FALLS
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State | ID
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Zip | 83301-5810
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Country | US
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Telephone | 517-227-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 18252 PINE MEADOWS DR
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City | THOMPSONVILLE
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State | MI
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Zip | 49683-9580
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Country | US
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Telephone | 517-227-7979
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-2646
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License Number State | ID
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