Active NPI
Kiesa Rene Carbin
- Massage Therapist
- Portland, OR
National Provider Identifier
1396419735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 25668
- Practice address
- 1413 SE Hawthorne Blvd
Portland, OR 97214-3640 - Phone
- (503) 841-6060
- NPI assigned
- Aug 8, 2021
- 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 | 25668 | OR | Primary |
Addresses
Primary practice location
1413 SE Hawthorne Blvd
Portland, OR 97214-3640
Mailing address
1550 SE Lava Dr Apt 17
Milwaukie, OR 97222-3401
Phone (310) 210-2063
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 |
|---|---|---|---|
| 25668 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628380800000",
"number": "1396419735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1550 SE LAVA DR APT 17",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972223401",
"telephone_number": "310-210-2063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1413 SE HAWTHORNE BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972143640",
"telephone_number": "503-841-6060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARBIN",
"first_name": "KIESA",
"middle_name": "RENE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-08",
"last_updated": "2021-08-08",
"certification_date": "2021-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "25668",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
- Claudia Y Caratachea
- Nicholas Bailey Johnson Carathers
- Caravan Counseling - Psychotherapy, LLC
- Linda Dee Caravia, LMT
- Consuelo Piedra Carbajal
- Carbon Health Medical Group of Florida PA
- Carbon Health Primary Care of Florida PA
- Rosa Jaime Carbonell, MD
- Sara Lucille Carbonneau, LAC
- Christina Willow Card
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.