Provider Demographics
NPI:1598199887
Name:BRIGHT, KATELYN D (LMT, NCTMB, MTI)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:D
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:LMT, NCTMB, MTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7156 HIGHWAY 518
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-9795
Mailing Address - Country:US
Mailing Address - Phone:432-557-1687
Mailing Address - Fax:
Practice Address - Street 1:7156 HIGHWAY 518
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557-9795
Practice Address - Country:US
Practice Address - Phone:432-557-1687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT113777225700000X
NM2023-0192225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist