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General NPI Number Information
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NPI Number | 1801467022
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Entity Type | Individual
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Provider Name | KELSEY JOHNSON LMT
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Gender | Female
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 2500 WILLAMETTE FALLS DR STE 207
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City | WEST LINN
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State | OR
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Zip | 97068-4722
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Country | US
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Telephone | 503-374-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 3415 SE 74TH AVE APT 20
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City | PORTLAND
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State | OR
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Zip | 97206-2455
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Country | US
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Telephone | 503-740-2641
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 19706
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License Number State | OR
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