Active NPI
Kelly J Wahl, LMT
- Massage Therapist
- Cheektowaga, NY
National Provider Identifier
1649527268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 020632-1
- Practice address
- 3083 William St
Suite 4
Cheektowaga, NY 14227-1933 - Phone
- (716) 544-0753
- Fax
- (716) 783-8727
- NPI assigned
- Aug 14, 2012
- 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 | 020632-1 | NY | Primary |
Addresses
Primary practice location
3083 William St
Suite 4
Cheektowaga, NY 14227-1933
Mailing address
3083 William Street
Suite 4
Cheektowaga, NY 14227
Phone (716) 544-0753
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 |
|---|---|---|---|
| 020632-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344902400000",
"number": "1649527268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3083 WILLIAM STREET",
"address_2": "SUITE 4",
"city": "CHEEKTOWAGA",
"state": "NY",
"postal_code": "14227",
"telephone_number": "716-544-0753",
"fax_number": "716-783-8727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3083 WILLIAM ST",
"address_2": "SUITE 4",
"city": "CHEEKTOWAGA",
"state": "NY",
"postal_code": "142271933",
"telephone_number": "716-544-0753",
"fax_number": "716-783-8727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAHL",
"first_name": "KELLY",
"middle_name": "J",
"name_prefix": "Ms.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-14",
"last_updated": "2012-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "020632-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cheektowaga, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.