Provider Demographics
NPI:1295221398
Name:BRINER, KAYLA RENAE (LMT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENAE
Last Name:BRINER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38131 SE SERBAN RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-7541
Mailing Address - Country:US
Mailing Address - Phone:419-551-1755
Mailing Address - Fax:
Practice Address - Street 1:38706 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8008
Practice Address - Country:US
Practice Address - Phone:419-551-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24080225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist