Individual provider Active NPI

Mikayla Cornett, LMT

  • Massage Therapist
  • Olympia, WA
National Provider Identifier
1780484261
Registry record updated Mar 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA61671554 Issued in WA
Practice address
4419 Harrison Ave NW Ste 107
Olympia, WA 98502-5087
Phone
(360) 581-3563
Fax
(360) 918-8843
NPI assigned
Mar 14, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MA61671554 WA Primary

Addresses

Primary practice location

4419 Harrison Ave NW Ste 107
Olympia, WA 98502-5087

Mailing address

583 Black Creek Rd
Montesano, WA 98563-9343

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

LicenseStateTypeSpecialty
MA61671554WAMDMassage Therapist

NPI Registry JSON

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

{
    "created_epoch": "1741910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1780484261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "583 BLACK CREEK RD",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985639343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4419 HARRISON AVE NW STE 107",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025087",
            "telephone_number": "360-581-3563",
            "fax_number": "360-918-8843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNETT",
        "first_name": "MIKAYLA",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-03-14",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61671554",
            "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 Mar 14, 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.