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NPI Code Detail

MEDICARE: HAILEY MARTIN MANTANONA

MEDICARE: HAILEY MARTIN MANTANONA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1487257440
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAILEY MARTIN MANTANONA
Provider Business Mailing Address
First Line : 11707 E SPRAGUE AVE STE 106
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99206-6124
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11707 E SPRAGUE AVE STE 106
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99206-6124
Country : US
Telephone Number : 509-999-5657
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2020
Last Update Date : 11/20/2020

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Directions to “ HAILEY MARTIN MANTANONA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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