Healthcare Provider Details

I. General information

NPI: 1598199887
Provider Name (Legal Business Name): KATELYN D BRIGHT LMT, NCTMB, MTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7156 HIGHWAY 518
RANCHOS DE TAOS NM
87557-9795
US

IV. Provider business mailing address

7156 HIGHWAY 518
RANCHOS DE TAOS NM
87557-9795
US

V. Phone/Fax

Practice location:
  • Phone: 432-557-1687
  • Fax:
Mailing address:
  • Phone: 432-557-1687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT113777
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2023-0192
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: