Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 00000904 | WA |
NPI | 1245821909 |
---|---|
Provider Name | Jillane Raines |
First Address | Kennewick, WA 99338-6024 |
Second Address | Kennewick, WA 99338-6024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2021 |
Last Update Date | 26/01/2021 |