Provider Demographics
NPI:1679248397
Name:BRAFF, KATELYNNE MARIE (CST, CSFA)
Entity Type:Individual
Prefix:
First Name:KATELYNNE
Middle Name:MARIE
Last Name:BRAFF
Suffix:
Gender:F
Credentials:CST, CSFA
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:BRAFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OR
Mailing Address - Zip Code:97352-9333
Mailing Address - Country:US
Mailing Address - Phone:503-910-6370
Mailing Address - Fax:
Practice Address - Street 1:1401 N 10TH AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1399
Practice Address - Country:US
Practice Address - Phone:503-769-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR187696246ZS0410X
OR202395246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist