Kimberly Diane Daniels, LMT
Individual provider Active NPI Massage Therapist · Canby, OR
NPI 1396216792 · NPPES record last updated Dec 10, 2018
Key facts
- NPI
- 1396216792
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 14684 (OR)
- Practice address
- 865 NW 6TH Ave
Canby, OR 97013-3303 - Phone
- (503) 263-6895
- NPI assigned
- Dec 10, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14684 | OR | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist |
225700000X | 14684 | OR | Yes |
Addresses
Primary practice location
865 NW 6TH Ave
Canby, OR 97013-3303
Mailing address
865 NW 6TH Ave
Canby, OR 97013-3303
Phone (503) 263-6895
Other providers in Canby, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.