Active NPI
Kylie Ecclestone
- Massage Therapist
- Salem, OR
National Provider Identifier
1013775808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 25470
- Practice address
- 6250 Club House Dr SE
Salem, OR 97306-9329 - Phone
- (503) 580-8762
- NPI assigned
- Mar 7, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 25470 | OR | Primary |
Addresses
Primary practice location
6250 Club House Dr SE
Salem, OR 97306-9329
Mailing address
870 Sahalee CT SE
Salem, OR 97306-9140
Phone (503) 580-8762
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25470 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709769600000",
"number": "1013775808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "870 SAHALEE CT SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973069140",
"telephone_number": "503-580-8762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6250 CLUB HOUSE DR SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973069329",
"telephone_number": "503-580-8762"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ECCLESTONE",
"first_name": "KYLIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-07",
"last_updated": "2024-03-07",
"certification_date": "2024-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "25470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.