Active NPI
Kristel Eden Wonderly
- Reflexologist
- Salem, OR
National Provider Identifier
1114174455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Reflexologist
- License
- 11433
- Practice address
- 3276 Commercial St SE
Salem, OR 97302-4584 - Phone
- (503) 749-2199
- NPI assigned
- Aug 19, 2008
- 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 |
|---|---|---|---|---|
| Reflexologist | 173C00000X | 11433 | OR | Primary |
Addresses
Primary practice location
3276 Commercial St SE
Salem, OR 97302-4584
Mailing address
1945 Garfield St NE
Salem, OR 97301-8153
Phone (503) 749-2199
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11433 | Other | OR | MASSAGE THERAPIST LICENSE |
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 |
|---|---|---|---|
| 11433 | OR | MD | Reflexologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219104000000",
"number": "1114174455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1945 GARFIELD ST NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973018153",
"telephone_number": "503-749-2199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3276 COMMERCIAL ST SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973024584",
"telephone_number": "503-749-2199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONDERLY",
"first_name": "KRISTEL",
"middle_name": "EDEN",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-19",
"last_updated": "2008-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "173C00000X",
"taxonomy_group": "",
"desc": "Reflexologist",
"state": "OR",
"license": "11433",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSAGE THERAPIST LICENSE",
"identifier": "11433",
"state": "OR"
}
],
"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 Aug 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.