Thomas C Licklider II, CO
Individual provider Active NPI Orthotist · Nebo, NC
NPI 1568782860 · NPPES record last updated Nov 4, 2011
Key facts
- NPI
- 1568782860
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthotist 222Z00000X
- Practice address
- 132 Forest Ridge Dr
Nebo, NC 28761-8708 - Phone
- (314) 757-5395
- NPI assigned
- Jun 9, 2010
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotist | 222Z00000X | Yes |
Addresses
Primary practice location
132 Forest Ridge Dr
Nebo, NC 28761-8708
Mailing address
132 Forest Ridge Dr
Nebo, NC 28761-8708
Other providers in Nebo, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.