Provider Demographics
NPI:1811276827
Name:BRALLEY, ROSALYN E (LMT)
Entity type:Individual
Prefix:MRS
First Name:ROSALYN
Middle Name:E
Last Name:BRALLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:LIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520
Mailing Address - Country:US
Mailing Address - Phone:541-821-3751
Mailing Address - Fax:541-779-7482
Practice Address - Street 1:300 HERSEY STREET, SUITE 4
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520
Practice Address - Country:US
Practice Address - Phone:541-821-6751
Practice Address - Fax:541-779-7482
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR174400000X
OR15531174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist