Active NPI
Shawn Kimberly Lavallee
- Massage Therapist
- Christmas Valley, OR
National Provider Identifier
1114153210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 14450
- Practice address
- 87520 Bay Rd.
North Lake Clinic
Christmas Valley, OR 97641 - Phone
- (541) 576-2110
- Fax
- (541) 576-2869
- NPI assigned
- Jun 3, 2009
- 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 | 14450 | OR | Primary |
Addresses
Primary practice location
87520 Bay Rd.
North Lake Clinic
Christmas Valley, OR 97641
Mailing address
57209 Freemont St.
Silver Lake, OR 97638
Phone (541) 576-2110
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 |
|---|---|---|---|
| 14450 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243987200000",
"number": "1114153210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "57209 FREEMONT ST.",
"city": "SILVER LAKE",
"state": "OR",
"postal_code": "97638",
"telephone_number": "541-576-2110",
"fax_number": "541-576-2869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "87520 BAY RD.",
"address_2": "NORTH LAKE CLINIC",
"city": "CHRISTMAS VALLEY",
"state": "OR",
"postal_code": "97641",
"telephone_number": "541-576-2110",
"fax_number": "541-576-2869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAVALLEE",
"first_name": "SHAWN",
"middle_name": "KIMBERLY",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-03",
"last_updated": "2009-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "14450",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Christmas Valley, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.