MEDICARE: TAYLOR S BRAMMER 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	2008-2505	WV

General Provider Information

NPI Number	:	1417194499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR S BRAMMER LMT

Provider Business Mailing Address
First Line	:	134 SILVER ST
Second Line	:
City	:	POCA
State	:	WV
Zip	:	25159-9702
Country	:	US
Telephone Number	:	304-382-5131
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 GOFF MOUNTAIN RD
Second Line	:	SUITE 13
City	:	CROSS LANES
State	:	WV
Zip	:	25313-6602
Country	:	US
Telephone Number	:	304-776-5031
Fax Number	:

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

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	01/14/2009

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Directions to “ TAYLOR S BRAMMER LMT” Practice Location

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