Active NPI
Courtney Lyn Dickerson, L.M.T.
- Massage Therapist
- Salem, OR
National Provider Identifier
1912246497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 18742
- Practice address
- 1880 Lancaster Dr NE
101, 102
Salem, OR 97305-1089 - Phone
- (503) 362-1002
- NPI assigned
- Feb 4, 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 | 18742 | OR | Primary |
Addresses
Primary practice location
1880 Lancaster Dr NE
101, 102
Salem, OR 97305-1089
Mailing address
141 SE Ash St
Dallas, OR 97338-2504
Phone (503) 871-9548
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 |
|---|---|---|---|
| 18742 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359936000000",
"number": "1912246497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "141 SE ASH ST",
"city": "DALLAS",
"state": "OR",
"postal_code": "973382504",
"telephone_number": "503-871-9548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1880 LANCASTER DR NE",
"address_2": "101, 102",
"city": "SALEM",
"state": "OR",
"postal_code": "973051089",
"telephone_number": "503-362-1002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "COURTNEY",
"middle_name": "LYN",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-02-04",
"last_updated": "2013-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "18742",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 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.