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General NPI Number Information
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NPI Number | 1316804198
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Entity Type | Organization
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Legal Business Name | CRYSTAL KELLEY MASSAGE LLC
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 456 STATE ST STE 100
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City | SALEM
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State | OR
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Zip | 97301-3619
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Country | US
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Telephone | 503-569-5339
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Fax |
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Provider Business Mailing Address
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Address Line | 3774 TAYSIDE ST S
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City | SALEM
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State | OR
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Zip | 97302-6802
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CRYSTAL KELLEY
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Credential |
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Telephone | 503-569-5339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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