Active NPI
Olivia Wycoff
- Massage Therapist
- Portland, OR
National Provider Identifier
1124273297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 15225
- Practice address
- 4512 SE Woodstock Blvd
Portland, OR 97206-6274 - Phone
- (503) 777-2776
- NPI assigned
- Nov 17, 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 15225 | OR | Primary |
Addresses
Primary practice location
4512 SE Woodstock Blvd
Portland, OR 97206-6274
Mailing address
7025 NE 8TH Ave
Portland, OR 97211-3523
Phone (920) 284-0293
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 |
|---|---|---|---|
| 15225 | OR | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodstock Wellness Center LLC | Past | Accepting new patients | |
| Woodstock Wellness Center | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Massage Therapist
- Portland, OR
- NPI 1467731380
-
- Acupuncturist
- Portland, OR
- NPI 1578730982
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226880000000",
"number": "1124273297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7025 NE 8TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972113523",
"telephone_number": "920-284-0293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4512 SE WOODSTOCK BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972066274",
"telephone_number": "503-777-2776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYCOFF",
"first_name": "OLIVIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-17",
"last_updated": "2008-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "15225",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.