Healthcare Provider Details

I. General information

NPI: 1346493798
Provider Name (Legal Business Name): JANELL LOUISE BRAGG LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 KAISER RD NW #2C
OLYMPIA WA
98502-2619
US

IV. Provider business mailing address

821 KAISER ROAD, NW #2C
OLYMPIA WA
98502
US

V. Phone/Fax

Practice location:
  • Phone: 360-259-4032
  • Fax:
Mailing address:
  • Phone: 360-259-4032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMAM00020115
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: