Active NPI
Olena Fosforova, LMBT
- Massage Therapist
- Charlotte, NC
National Provider Identifier
1891222303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 12549
- Practice address
- 1100 S Mint St Ste 109
Charlotte, NC 28203-4058 - Phone
- (704) 763-9044
- NPI assigned
- May 15, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 | 12549 | NC | Primary |
Addresses
Primary practice location
1100 S Mint St Ste 109
Charlotte, NC 28203-4058
Mailing address
1100 S Mint St Ste 109
Charlotte, NC 28203-4058
Phone (704) 763-9044
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 |
|---|---|---|---|
| 12549 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1891222303",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 S MINT ST STE 109",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282034058",
"telephone_number": "704-763-9044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 S MINT ST STE 109",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282034058",
"telephone_number": "704-763-9044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOSFOROVA",
"first_name": "OLENA",
"credential": "LMBT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-15",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "NC",
"license": "12549",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
- Fortuity Home Health & Senior Care
- Fortune Heart of North Carolina Home Care LLC
- Tamatha S. Fortune, LPCA, NCC, CCMC
- William Joseph Fortuner II, MD
- Forward Motion Enterprise LLC
- Nathanael David Foss, DPT
- Melanie Nicole Fossinger, NP
- Alexus Rae Foster
- Amy Beth Foster, LAT, ATC
- Emmerita Foster, M.S.W., L.C.S.W.A.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.