Active NPI
Kelli Marie Jacobs, LMT
- Massage Therapist
- Bedford, OH
National Provider Identifier
1235975509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 33.025743
- Practice address
- 704 Broadway Ave FL 2
Bedford, OH 44146-3642 - Phone
- (216) 218-5018
- NPI assigned
- Jul 5, 2024
- Sex
- Female
- 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 | 33.025743 | OH | Primary |
Addresses
Primary practice location
704 Broadway Ave FL 2
Bedford, OH 44146-3642
Mailing address
704 Broadway Ave FL 2
Bedford, OH 44146-3642
Phone (216) 218-5018
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 |
|---|---|---|---|
| 33.025743 | OH | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720137600000",
"number": "1235975509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "704 BROADWAY AVE FL 2",
"city": "BEDFORD",
"state": "OH",
"postal_code": "441463642",
"telephone_number": "216-218-5018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "704 BROADWAY AVE FL 2",
"city": "BEDFORD",
"state": "OH",
"postal_code": "441463642",
"telephone_number": "216-218-5018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "KELLI",
"middle_name": "MARIE",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-05",
"last_updated": "2024-07-05",
"certification_date": "2024-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OH",
"license": "33.025743",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bedford, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.