MEDICARE: RACHEL KAUTZMAN BCBA

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	222Q00000X	Developmental Therapist	1-21-52219	ID
2	103K00000X	Behavior Analyst		WA

General Provider Information

NPI Number	:	1568942217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL KAUTZMAN BCBA

Provider Business Mailing Address
First Line	:	627 E. LACROSSE AVE.
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99207
Country	:	US
Telephone Number	:	509-991-2102
Fax Number	:

Provider Business Practice Location Address
First Line	:	7905 N MEADOWLARK WAY # C-D
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-5041
Country	:	US
Telephone Number	:	208-618-2593
Fax Number	:

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

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	01/22/2026

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