Healthcare Provider Details

I. General information

NPI: 1033058722
Provider Name (Legal Business Name): KELSEY NEBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W B ST STE J
SPRINGFIELD OR
97477-4594
US

IV. Provider business mailing address

637 19TH ST
SPRINGFIELD OR
97477-4211
US

V. Phone/Fax

Practice location:
  • Phone: 541-636-3905
  • Fax: 541-505-9023
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29423
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: