MEDICARE: KAYLA RENAE BRINER 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	24080	OR

General Provider Information

NPI Number	:	1295221398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA RENAE BRINER LMT

Provider Business Mailing Address
First Line	:	38131 SE SERBAN RD
Second Line	:
City	:	SANDY
State	:	OR
Zip	:	97055-7541
Country	:	US
Telephone Number	:	419-551-1755
Fax Number	:

Provider Business Practice Location Address
First Line	:	38706 PIONEER BLVD
Second Line	:
City	:	SANDY
State	:	OR
Zip	:	97055-8008
Country	:	US
Telephone Number	:	419-551-1755
Fax Number	:

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

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	07/02/2018

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Directions to “ KAYLA RENAE BRINER LMT” Practice Location

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