Provider Demographics
NPI:1811555048
Name:SPALDING, KAITLYN SUE
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:SUE
Last Name:SPALDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18252 PINE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:THOMPSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49683-9580
Mailing Address - Country:US
Mailing Address - Phone:517-227-7979
Mailing Address - Fax:
Practice Address - Street 1:801 POLE LINE RD W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5810
Practice Address - Country:US
Practice Address - Phone:517-227-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IDOT-2646225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)