MEDICARE: CAILA FAUTENBERRY RBT

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	103K00000X	Behavior Analyst	CB60775476	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487136370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAILA FAUTENBERRY RBT

Provider Business Mailing Address
First Line	:	2559 S WATERBURY LN
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-4981
Country	:	US
Telephone Number	:	805-668-8961
Fax Number	:	208-416-6922

Provider Business Practice Location Address
First Line	:	1420 NW GILMAN BLVD STE 2604
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-5394
Country	:	US
Telephone Number	:	805-668-8961
Fax Number	:	208-416-6922

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

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	09/06/2018

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Directions to “ CAILA FAUTENBERRY RBT” Practice Location

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