Active NPI
Jessica L Sullivan, LMT
- Massage Therapist
- Olympia, WA
National Provider Identifier
1740440379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA60590036
- Practice address
- 3015 Limited LN NW
Ste B
Olympia, WA 98502-2638 - Phone
- (360) 709-0700
- Fax
- (360) 709-0703
- NPI assigned
- Jun 17, 2008
- 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 | MA60590036 | WA | Primary |
Addresses
Primary practice location
3015 Limited LN NW
Ste B
Olympia, WA 98502-2638
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
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 |
|---|---|---|---|
| MA60590036 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453680000000",
"number": "1740440379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3015 LIMITED LN NW",
"address_2": "STE B",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985022638",
"telephone_number": "360-709-0700",
"fax_number": "360-709-0703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "JESSICA",
"middle_name": "L",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-17",
"last_updated": "2016-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA60590036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 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.