MEDICARE: MRS. DONNA A BRAINARD LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	015620	NY

General Provider Information

NPI Number	:	1417176777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA A BRAINARD LMT

Provider Business Mailing Address
First Line	:	1469 PERRY ROAD
Second Line	:
City	:	NORTH JAVA
State	:	NY
Zip	:	14113
Country	:	US
Telephone Number	:	585-535-0518
Fax Number	:

Provider Business Practice Location Address
First Line	:	1469 PERRY ROAD
Second Line	:
City	:	NORTH JAVA
State	:	NY
Zip	:	14113
Country	:	US
Telephone Number	:	585-535-0518
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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