Active NPI
Lori McNickle, CPED, RFOM
- Pedorthist
- Canton, OH
National Provider Identifier
1861733396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pedorthist
- License
- LPED32
- Practice address
- 4663 Whipple Ave NW
Canton, OH 44718-2615 - Phone
- (330) 479-0020
- Fax
- (330) 493-5759
- NPI assigned
- Mar 7, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pedorthist | 224L00000X | LPED32 | OH | Primary |
Addresses
Primary practice location
4663 Whipple Ave NW
Canton, OH 44718-2615
Mailing address
4663 Whipple Ave NW
Canton, OH 44718-2615
Phone (330) 479-0020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2002862 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPED32 | OH | MD | Pedorthist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362614400000",
"number": "1861733396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4663 WHIPPLE AVE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447182615",
"telephone_number": "330-479-0020",
"fax_number": "330-493-5759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4663 WHIPPLE AVE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447182615",
"telephone_number": "330-479-0020",
"fax_number": "330-493-5759"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCNICKLE",
"first_name": "LORI",
"credential": "CPED, RFOM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-07",
"last_updated": "2013-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "224L00000X",
"taxonomy_group": "",
"desc": "Pedorthist",
"state": "OH",
"license": "LPED32",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2002862",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.