| Doctor Name: | KELLY RAINWATER |
| NPI Number: | 1205265238 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 53900 442nd Avenue Talihina, OK - 745711022 |
| Business Phone Number: | 9184135600 |
| Business Fax Number: | 9185672382 |
| Mailing Address: | Po Box 1022, TALIHINA |
| State: | OK |
| Postal Code: | 745711022 |
| Phone Number: | 9184135600 |
| Fax Number: | 9185672382 |
| NPI Enumeration Date: | 11/12/2013 |
| NPI Last Update Date: | 11/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |