Active NPI
Amber Dawn Carroll, MT
- Massage Therapist
- Bend, OR
National Provider Identifier
1295418804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 26974
- Practice address
- 1554 NE 4TH St Ste 3
Bend, OR 97701-4240 - Phone
- (541) 419-2390
- NPI assigned
- Aug 9, 2023
- 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 | 26974 | OR | Primary |
Addresses
Primary practice location
1554 NE 4TH St Ste 3
Bend, OR 97701-4240
Mailing address
PO Box 2211
Redmond, OR 97756-0540
Phone (541) 419-2390
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26974 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691539200000",
"number": "1295418804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2211",
"city": "REDMOND",
"state": "OR",
"postal_code": "977560540",
"telephone_number": "541-419-2390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1554 NE 4TH ST STE 3",
"city": "BEND",
"state": "OR",
"postal_code": "977014240",
"telephone_number": "541-419-2390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "AMBER",
"middle_name": "DAWN",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-08-09",
"last_updated": "2023-08-09",
"certification_date": "2023-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "26974",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.