Active NPI
Connie L Koczur
- Massage Therapist
- Sublimity, OR
National Provider Identifier
1700178134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 17959
- Practice address
- 12113 Golf LN SE
Sublimity, OR 97385-9707 - Phone
- (503) 910-8663
- NPI assigned
- May 4, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 17959 | OR | Primary |
| Home Health Aide | 374U00000X | 795072 | OR |
Addresses
Primary practice location
12113 Golf LN SE
Sublimity, OR 97385-9707
Mailing address
PO Box 558
Sublimity, OR 97385-0558
Phone (503) 910-8663
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 |
|---|---|---|---|
| 17959 | OR | MD | Massage Therapist |
| 795072 | OR | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458864000000",
"number": "1700178134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 558",
"city": "SUBLIMITY",
"state": "OR",
"postal_code": "973850558",
"telephone_number": "503-910-8663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12113 GOLF LN SE",
"city": "SUBLIMITY",
"state": "OR",
"postal_code": "973859707",
"telephone_number": "503-910-8663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOCZUR",
"first_name": "CONNIE",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-04",
"last_updated": "2016-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "17959",
"primary": true
},
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "OR",
"license": "795072",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sublimity, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.