Active NPI
Collette Michelle Wilson, LMT
- Massage Therapist
- Pahala, HI
National Provider Identifier
1205994183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MAT-12043
- Practice address
- 96-1100 Kamani Street
Pahala, HI 96777-0067 - Phone
- (808) 987-7490
- NPI assigned
- Dec 5, 2006
- Last updated
- Aug 26, 2026
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA00021673 | WA | |
| Massage Therapist | 225700000X | MAT-12043 | HI | Primary |
Addresses
Primary practice location
96-1100 Kamani Street
Pahala, HI 96777-0067
Mailing address
PO Box 67
Pahala, HI 96777-0067
Phone (808) 987-7490
Other practice location 1
94-2166 South Point Road
Naalehu, HI 96772
Phone (808) 987-7490
Other practice location 2
PO Box 721426
Naalehu, HI 96772-1119
Phone (808) 987-7490
Other practice location 3
PO Box 67
Pahala, HI 96777-0067
Phone (808) 987-7490
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 |
|---|---|---|---|
| MAT-12043 | HI | MD | Massage Therapist |
| MA00021673 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787702400000",
"number": "1205994183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 67",
"city": "PAHALA",
"state": "HI",
"postal_code": "967770067",
"telephone_number": "808-987-7490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "96-1100 KAMANI STREET",
"city": "PAHALA",
"state": "HI",
"postal_code": "967770067",
"telephone_number": "808-987-7490"
}
],
"practiceLocations": [
{
"address_1": "94-2166 South Point Road",
"address_purpose": "LOCATION",
"city": "Naalehu",
"state": "HI",
"postal_code": "96772",
"country_code": "US",
"telephone_number": "808-987-7490",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "PO Box 721426",
"address_purpose": "LOCATION",
"city": "Naalehu",
"state": "HI",
"postal_code": "967721119",
"country_code": "US",
"telephone_number": "808-987-7490",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "PO Box 67",
"address_purpose": "LOCATION",
"city": "Pahala",
"state": "HI",
"postal_code": "967770067",
"country_code": "US",
"telephone_number": "808-987-7490",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "COLLETTE",
"middle_name": "MICHELLE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-05",
"last_updated": "2026-08-26",
"certification_date": "2026-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA00021673",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "HI",
"license": "MAT-12043",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pahala, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.