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NPI Code Detail

MEDICARE: KACIE ANN-LOUISE BRAHAM L.M.T.

MEDICARE: KACIE ANN-LOUISE BRAHAM L.M.T.
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
1174400000XSpecialist13739OR

General Provider Information

NPI Number : 1952528564
Entity Type Code : Individual
Provider Name (Legal Business Name) : KACIE ANN-LOUISE BRAHAM L.M.T.
Provider Business Mailing Address
First Line : 11918 SE DIVISION ST # 291
Second Line :
City : PORTLAND
State : OR
Zip : 97266-1037
Country : US
Telephone Number : 541-292-3757
Fax Number : 503-223-1188
Provider Business Practice Location Address
First Line : 5517 N COMMERCIAL AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97217-2339
Country : US
Telephone Number : 541-292-3757
Fax Number : 503-223-1188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 03/22/2013

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