Active NPI
Jessica Marie Fodge, L.M.T.
- Massage Therapist
- Okanogan, WA
National Provider Identifier
1891836946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA00011423
- Practice address
- 233 2ND Ave S
Okanogan, WA 98840-9703 - Phone
- (509) 429-0096
- NPI assigned
- Feb 10, 2007
- Last updated
- Dec 22, 2024
- 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 | MA00011423 | WA | Primary |
Addresses
Primary practice location
233 2ND Ave S
Okanogan, WA 98840-9703
Mailing address
PO Box 1604
Okanogan, WA 98840-1604
Phone (509) 331-6308
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 |
|---|---|---|---|
| MA00011423 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734825600000",
"number": "1891836946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1604",
"city": "OKANOGAN",
"state": "WA",
"postal_code": "988401604",
"telephone_number": "509-331-6308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "233 2ND AVE S",
"city": "OKANOGAN",
"state": "WA",
"postal_code": "988409703",
"telephone_number": "509-429-0096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FODGE",
"first_name": "JESSICA",
"middle_name": "MARIE",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-10",
"last_updated": "2024-12-22",
"certification_date": "2024-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA00011423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Okanogan, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.