Provider Demographics
NPI:1689403206
Name:BRAATEN, DEVIN JAMEA (NMT)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:JAMEA
Last Name:BRAATEN
Suffix:
Gender:M
Credentials:NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 LEONARD LN
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-7911
Mailing Address - Country:US
Mailing Address - Phone:406-300-2904
Mailing Address - Fax:
Practice Address - Street 1:1369 SOPHIE LAKE RD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-9139
Practice Address - Country:US
Practice Address - Phone:406-300-2904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-23187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist