Provider Demographics
NPI:1245821909
Name:RAINES, JILLANE (OTD)
Entity type:Individual
Prefix:
First Name:JILLANE
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73804 E GRAND BLUFF LOOP
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-6024
Mailing Address - Country:US
Mailing Address - Phone:843-422-0099
Mailing Address - Fax:
Practice Address - Street 1:73804 E GRAND BLUFF LOOP
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-6024
Practice Address - Country:US
Practice Address - Phone:843-422-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000904225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology