Active NPI
Alicia J Jackson, MASSAGE THERAPIST
- Massage Therapist
- Oklahoma City, OK
National Provider Identifier
1902245988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- OCC04318
- Practice address
- 11200 N Portland Ave
Oklahoma City, OK 73120-5045 - Phone
- (405) 936-1550
- Fax
- (405) 936-1559
- NPI assigned
- Jun 23, 2013
- Last updated
- Jun 23, 2013
- 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 | OCC04318 | OK | Primary |
Addresses
Primary practice location
11200 N Portland Ave
Oklahoma City, OK 73120-5045
Mailing address
508 Brighton Dr
Edmond, OK 73003-3169
Phone (405) 204-0505
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 |
|---|---|---|---|
| OCC04318 | OK | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371945600000",
"number": "1902245988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "508 BRIGHTON DR",
"city": "EDMOND",
"state": "OK",
"postal_code": "730033169",
"telephone_number": "405-204-0505",
"fax_number": "405-936-1559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11200 N PORTLAND AVE",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731205045",
"telephone_number": "405-936-1550",
"fax_number": "405-936-1559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ALICIA",
"middle_name": "J",
"credential": "MASSAGE THERAPIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-23",
"last_updated": "2013-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OK",
"license": "OCC04318",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.