Active NPI
Shane Kooken-Hover, L.M.T.
- Massage Therapist
- Tigard, OR
National Provider Identifier
1154775799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 19795
- Practice address
- 12700 SW North Dakota St
Ste 180
Tigard, OR 97223-0802 - Phone
- (503) 716-8281
- Fax
- (503) 716-8783
- NPI assigned
- Apr 20, 2016
- Sex
- Male
- Sole proprietor
- No
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 | 19795 | OR | Primary |
Addresses
Primary practice location
12700 SW North Dakota St
Ste 180
Tigard, OR 97223-0802
Mailing address
11795 SW Tualatin Rd
#67
Tualatin, OR 97062-7444
Phone (503) 422-1865
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 |
|---|---|---|---|
| 19795 | OR | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Straight Up Chiropractic | Past | Accepting new patients | |
| Gregory Oltmann DC LLC | 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.
-
- Chiropractor
- Tigard, OR
- NPI 1184406738
-
- Health Service Clinic/Center
- Tigard, OR
- NPI 1932579661
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461110400000",
"number": "1154775799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11795 SW TUALATIN RD",
"address_2": "#67",
"city": "TUALATIN",
"state": "OR",
"postal_code": "970627444",
"telephone_number": "503-422-1865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12700 SW NORTH DAKOTA ST",
"address_2": "STE 180",
"city": "TIGARD",
"state": "OR",
"postal_code": "972230802",
"telephone_number": "503-716-8281",
"fax_number": "503-716-8783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOOKEN-HOVER",
"first_name": "SHANE",
"credential": "L.M.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-04-20",
"last_updated": "2016-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "19795",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.