NPIMap

Individual provider Active NPI

Stuart Orlo Kelley Jr.

  • Massage Therapist
  • Vancouver, WA
National Provider Identifier
1861744146
Registry record updated Oct 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA60142841 Issued in WA
Practice address
6700 NE 162ND Ave Ste 415
Vancouver, WA 98682-3863
Phone
(360) 882-0767
NPI assigned
Oct 10, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2012

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 MA60142841 WA Primary

Addresses

Primary practice location

6700 NE 162ND Ave Ste 415
Vancouver, WA 98682-3863

Mailing address

6700 NE 162ND Ave Ste 415
Vancouver, WA 98682-3863
Phone (360) 882-0767

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
MA60142841WAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kelly Chiropractic, PS Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349827200000",
    "number": "1861744146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 NE 162ND AVE STE 415",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986823863",
            "telephone_number": "360-882-0767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6700 NE 162ND AVE STE 415",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986823863",
            "telephone_number": "360-882-0767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "STUART",
        "middle_name": "ORLO",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-10",
        "last_updated": "2012-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60142841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; 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.