Provider Demographics
NPI:1326655481
Name:ENOSA, CALISTA TAYLOR (BA)
Entity Type:Individual
Prefix:MRS
First Name:CALISTA
Middle Name:TAYLOR
Last Name:ENOSA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W 7TH ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-2471
Mailing Address - Country:US
Mailing Address - Phone:360-789-6786
Mailing Address - Fax:
Practice Address - Street 1:526 5TH ST
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-1619
Practice Address - Country:US
Practice Address - Phone:509-359-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer