Provider Demographics
NPI:1336507979
Name:DRAYTON, TANYA (LMT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:DRAYTON
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 1:215 MARCUS ST STE 208
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3220
Mailing Address - Country:US
Mailing Address - Phone:406-642-3665
Mailing Address - Fax:
Practice Address - Street 1:215 MARCUS ST STE 208
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3220
Practice Address - Country:US
Practice Address - Phone:406-642-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-1309225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist