Healthcare Provider Details

I. General information

NPI: 1285022814
Provider Name (Legal Business Name): SHELLY JENKINS MT-BC, FDN-P, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 NW 2ND AVE
ONTARIO OR
97914-1960
US

IV. Provider business mailing address

2138 NW 2ND AVE
ONTARIO OR
97914-1960
US

V. Phone/Fax

Practice location:
  • Phone: 541-212-1716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: