Individual
LORI M LICKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
150 MAYA CIR, CENTRAL ISLIP, NY 11722-4542
(631) 730-6401
Mailing address
150 MAYA CIR, CENTRAL ISLIP, NY 11722-4542
(631) 730-6401
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
2506
NY
Other
Enumeration date
09/18/2010
Last updated
09/18/2010
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