Healthcare Provider Details

I. General information

NPI: 1336393545
Provider Name (Legal Business Name): KERI SELLS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 SW MADISON AVE STE 108
CORVALLIS OR
97333-4591
US

IV. Provider business mailing address

3004 23RD AVE NW
ALBANY OR
97321-6510
US

V. Phone/Fax

Practice location:
  • Phone: 541-286-5114
  • Fax:
Mailing address:
  • Phone: 352-278-3185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18664
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: