Provider Demographics
NPI:1417194499
Name:BRAMMER, TAYLOR S (LMT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:S
Last Name:BRAMMER
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 1:134 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:POCA
Mailing Address - State:WV
Mailing Address - Zip Code:25159-9702
Mailing Address - Country:US
Mailing Address - Phone:304-382-5131
Mailing Address - Fax:
Practice Address - Street 1:314 GOFF MOUNTAIN RD
Practice Address - Street 2:SUITE 13
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-6602
Practice Address - Country:US
Practice Address - Phone:304-776-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2008-2505225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist