Willamette Wine Spa LLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

Legal business name

WILLAMETTE WINE SPA LLC

Practice address

1517 NE Broadway St
Portland, OR 97232-1406

Phone

(503) 946-8450

NPI assigned

Oct 31, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Lewis

Title

Founder

Phone

(808) 341-1583

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jamie Tinsley-Shannon Rolan, LMT

  • Massage Therapist
  • Portland, OR
  • NPI 1437979176
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1761868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761868800000",
    "number": "1740159532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1838 NE WASCO ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1517 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321406",
            "telephone_number": "503-946-8450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE WINE SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-31",
        "last_updated": "2025-10-31",
        "certification_date": "2025-10-31",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "808-341-1583"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willamette Pharmacy
• Willamette Therapy
• Willamette Valley Immunology Center PC
• Willamette Valley Iom, LLC
• Willamette View Inc.
• Michelle Willams, M.D.
• Sherri Willard Argyres
• Edyth Adele Willard, PHARM D
• Gregory Willard, DC
• Carol Shychy Willeford, PMHNP

• Massage Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Massage Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.