MEDICARE: KERRIE L SPAIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1407734981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRIE L SPAIN

Provider Business Mailing Address
First Line	:	7362 W PARKS HWY # 834
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99623-9300
Country	:	US
Telephone Number	:	907-841-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	7362 W PARKS HWY # 834
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99623-9300
Country	:	US
Telephone Number	:	907-841-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2025
Last Update Date	:	08/23/2025

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