Bonnie Lee Mickelson

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

909 Issued in MT

Practice address

805 Nucleus Ave.
Columbia Falls, MT 59912

Phone

(406) 892-5304

Fax

(406) 892-4038

NPI assigned

Mar 21, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332288000000",
    "number": "1982979126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "597 LEGACY LN",
            "city": "COLUMBIA FALLS",
            "state": "MT",
            "postal_code": "59912",
            "telephone_number": "406-892-5304",
            "fax_number": "406-892-4038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 NUCLEUS AVE.",
            "city": "COLUMBIA FALLS",
            "state": "MT",
            "postal_code": "59912",
            "telephone_number": "406-892-5304",
            "fax_number": "406-892-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "BONNIE",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-21",
        "last_updated": "2012-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173C00000X",
            "taxonomy_group": "",
            "desc": "Reflexologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MT",
            "license": "909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christi Masters, L.AC.
• Amanda McCurdy
• Scott McFarlane, LCSW
• Angela McLauchlin
• Tea Mergenthaler, PTA
• Joan Miller, MD
• John F Miller, DDS
• Dawn M Moles, LCPC-C
• Montana Med Supply
• Montana Vamc

• Massage Therapist in Columbia Falls, MT
• Providers in Columbia Falls, MT by specialty
• Massage Therapist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 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.