Carolyn Michelle Adelaide, LMT
Individual provider Active NPI Massage Therapist · Broken Arrow, OK
NPI 1831570167 · NPPES record last updated Jul 18, 2026
Key facts
- NPI
- 1831570167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 7501004307 (MI)
- Practice address
- 1905 S Gardenia Ave
Broken Arrow, OK 74012-9041 - Phone
- (918) 891-1373
- Fax
- (918) 891-1373
- NPI assigned
- Jun 11, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7501004307 | MI | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 7501004307 | MI | Yes |
Addresses
Primary practice location
1905 S Gardenia Ave
Broken Arrow, OK 74012-9041
Mailing address
1905 S Gardenia Ave
Broken Arrow, OK 74012-9041
Phone (918) 891-1373
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All providers in Broken Arrow, OK · Massage Therapist in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.