Provider Demographics
NPI:1003118548
Name:BRAUNS, KATIE (LMT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BRAUNS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KATHERINE
Other - Last Name:BRAUNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1584 NW ITHACA AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2116
Mailing Address - Country:US
Mailing Address - Phone:541-788-4116
Mailing Address - Fax:
Practice Address - Street 1:243 SW SCALEHOUSE LOOP STE 2B
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1279
Practice Address - Country:US
Practice Address - Phone:541-388-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17083171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor