Active NPI
Shannon Aimee Kelley, LMT
- Massage Therapist
- Snohomish, WA
National Provider Identifier
1295422863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA61423070
- Practice address
- 112 Avenue D Unit a
Snohomish, WA 98290-2743 - Phone
- (360) 863-2412
- NPI assigned
- Apr 24, 2023
- 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 | MA61423070 | WA | Primary |
Addresses
Primary practice location
112 Avenue D Unit a
Snohomish, WA 98290-2743
Mailing address
8111 145TH Dr SE Unit 1
Snohomish, WA 98290-9080
Phone (425) 530-0380
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 |
|---|---|---|---|
| MA61423070 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682294400000",
"number": "1295422863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8111 145TH DR SE UNIT 1",
"city": "SNOHOMISH",
"state": "WA",
"postal_code": "982909080",
"telephone_number": "425-530-0380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 AVENUE D UNIT A",
"city": "SNOHOMISH",
"state": "WA",
"postal_code": "982902743",
"telephone_number": "360-863-2412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "SHANNON",
"middle_name": "AIMEE",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-24",
"last_updated": "2023-04-24",
"certification_date": "2023-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA61423070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Snohomish, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.