Provider Demographics
NPI:1194946061
Name:BRACKETT, JAYME LEIGH (LMP)
Entity type:Individual
Prefix:MRS
First Name:JAYME
Middle Name:LEIGH
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3121 W KENNEWICK AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2921
Mailing Address - Country:US
Mailing Address - Phone:509-735-7433
Mailing Address - Fax:509-735-6577
Practice Address - Street 1:3121 W KENNEWICK AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2921
Practice Address - Country:US
Practice Address - Phone:509-735-7433
Practice Address - Fax:509-735-6577
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019087225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist