Jennifer Sullivan
Individual provider Active NPI Massage Therapist · Creswell, OR
NPI 1851907232 · NPPES record last updated Sep 21, 2020
Key facts
- NPI
- 1851907232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 24449 (OR)
- Practice address
- 82884 N Pacific Hwy
Creswell, OR 97426-9407 - Phone
- (541) 514-0131
- NPI assigned
- Sep 21, 2020
- 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 |
|---|---|---|---|
| 24449 | OR | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 24449 | OR | Yes |
Addresses
Primary practice location
82884 N Pacific Hwy
Creswell, OR 97426-9407
Mailing address
82884 N Pacific Hwy
Creswell, OR 97426-9407
Phone (541) 514-0131
NPI Registry JSON
{
"created_epoch": "1600646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600646400000",
"number": "1851907232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "82884 N PACIFIC HWY",
"city": "CRESWELL",
"state": "OR",
"postal_code": "974269407",
"telephone_number": "541-514-0131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "82884 N PACIFIC HWY",
"city": "CRESWELL",
"state": "OR",
"postal_code": "974269407",
"telephone_number": "541-514-0131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-21",
"last_updated": "2020-09-21",
"certification_date": "2020-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "24449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Creswell, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2020. 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.