Doctor Name: | CAROLYN P BRAINARD |
NPI Number: | 1609967090 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | MA00012404 |
Business Practice Address: | 1172 W Hayden Ave Hayden, ID - 838358700 |
Business Phone Number: | 2087623332 |
Business Fax Number: | 2087624268 |
Mailing Address: | 1917 N Lakewood Dr, COEUR D ALENE |
State: | ID |
Postal Code: | 838142634 |
Phone Number: | 2086648194 |
Fax Number: | 2086671847 |
NPI Enumeration Date: | 09/28/2006 |
NPI Last Update Date: | 03/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA00012404 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |