SHELLY R CARLSON (NPI# 1174146948) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174146948 |
| Entity Type | Individual |
| Full Name | SHELLY R CARLSON |
| Credential | QMHA |
| Practice Address |
3723 Fairview Industrial Dr Se Ste 170 Salem OR 97302-1174 |
| Practice Telephone | 5033711970 |
| Practice Fax Number | 5033710192 |
| Mailing Telephone | 5033711970 |
| Mailing Fax Number | 5033710192 |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2020-05-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225400000X | Rehabilitation Practitioner | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
3723 FAIRVIEW INDUSTRIAL DR SE STE 170 |
| City | SALEM |
| State | OR |
| Zip Code | 97302-1174 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275795619 | Coaction, Inc. | Clinic/Center | 3723 Fairview Industrial Dr Se Ste 170, Salem, OR 97302-1174 | 2008-06-26 |
| 1972131001 | Victoria R Padron | Dietitian, Registered | 3723 Fairview Industrial Dr Se Ste 170, Salem, OR 97302-1174 | 2020-04-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952954679 | Eric Anthony Bohm | Pharmacist | 2757 22nd St. Se, Salem, OR 97302 | 2019-07-22 |
| 1598223737 | Michael Robert Martini | Counselor | 960 Liberty Rd Se Suite 120, Salem, OR 97302 | 2019-03-06 |
| 1659857480 | Avalina Pharmacy Inc | Pharmacy | 3507 Commercial St Se, Salem, OR 97302 | 2018-07-16 |
| 1649762733 | Joseph Bochsler | Physical Therapist | 3220 Liberty Rd. S., Salem, OR 97302 | 2018-06-04 |
| 1922533652 | Brianne Elizabeth Sischo | Licensed Practical Nurse | 3871 Fairview Industrial Dr. Se Ste, 150, Salem, OR 97302 | 2017-05-01 |
| 1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
| 1720529803 | Nicholas Forsberg | Massage Therapist | 126 Mize Rd S, Salem, OR 97302 | 2017-03-09 |
| 1437691078 | Kimo Mahi | Specialist/Technologist, Other | 2373 Kuebler Rd. S, Salem, OR 97302 | 2016-11-14 |
| 1588113278 | New Life Family Medicine LLC | Clinic/Center | 842 Commercial Street Ne, Salem, OR 97302 | 2016-09-23 |
| 1073060117 | Susan Morag Robnett | Counselor | 912 Fir Street South, Salem, OR 97302 | 2016-09-07 |
| Find all providers in zip 97302 | ||||
| Taxonomy Code | 225400000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Rehabilitation Practitioner |
| A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427051259 | Lee Eugene Vranna | Rehabilitation Practitioner | 890 Oak St Se, Salem, OR 97301 | 2005-05-24 |
| 1902206055 | Marissa Ann Senger | Rehabilitation Practitioner | 3445 Boone Rd Se, Salem, OR 97317-9336 | 2014-08-26 |
| 1346429644 | Western Reserve Rehab Group LLC | Rehabilitation Practitioner | 2561 Center St Ne, Salem, OR 97301-4600 | 2007-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023616422 | Joseph Gorecki | Rehabilitation Practitioner | 3303 S Bond Ave Bldg 115th, Portland, OR 97239-4501 | 2020-10-16 |
| 1992056857 | Beth W. Mantis | Rehabilitation Practitioner | 29544 Se Heiple Rd, Eagle Creek, OR 97022-9664 | 2012-10-01 |
| 1144556861 | Du Nguyen | Rehabilitation Practitioner | 283 Nw 182nd Ave, Beaverton, OR 97006-3413 | 2009-10-30 |
| 1235385139 | Maureen Benedict-lee | Rehabilitation Practitioner | 1636 Se Taylor St, Apt. 5, Portland, OR 97214-2678 | 2008-08-11 |
| 1124288840 | Donita Zoe Diamata | Rehabilitation Practitioner | 10150 Se Ankeny St Ste 201a, Portland, OR 97216-2369 | 2008-06-16 |
| 1518923200 | Paulette Ann Richards | Rehabilitation Practitioner | 24820 Paradise Drive, Junction City, OR 97448 | 2006-04-22 |
| 1275131682 | Suzanne Lynn Groth | Rehabilitation Practitioner | 3303 S Bond Ave, Portland, OR 97239-4501 | 2020-10-16 |
| 1699290072 | Jennifer Lynn Habada | Rehabilitation Practitioner | 4317 Ne Tillamook St, Portland, OR 97213-1315 | 2017-08-07 |
| 1013443548 | Amanda Garrison | Rehabilitation Practitioner | 18218 Sw Horse Tale Dr, Beaverton, OR 97007-9789 | 2017-05-03 |
| 1700204658 | Nick Benas | Rehabilitation Practitioner | 2120 Exchange St, Suite 301, Astoria, OR 97103-3365 | 2014-03-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.