Provider Demographics
NPI:1184480782
Name:RAUTHE, SANDRA FAYE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:FAYE
Last Name:RAUTHE
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 1:144 MANY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-8390
Mailing Address - Country:US
Mailing Address - Phone:406-250-9651
Mailing Address - Fax:
Practice Address - Street 1:144 MANY LAKES DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-8390
Practice Address - Country:US
Practice Address - Phone:406-250-9651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services