Provider Demographics
NPI:1477019479
Name:BRINLEE, JESSY LEE (LMT)
Entity Type:Individual
Prefix:
First Name:JESSY
Middle Name:LEE
Last Name:BRINLEE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JESSY
Other - Middle Name:LEE
Other - Last Name:BRINLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:424 NE FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4919
Mailing Address - Country:US
Mailing Address - Phone:541-388-3588
Mailing Address - Fax:541-388-0839
Practice Address - Street 1:424 NE FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4919
Practice Address - Country:US
Practice Address - Phone:541-388-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20343225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR20343OtherLICENSE NUMBER
20343OtherLICENSE NUMBER