Individual
ELLIE HICKLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
55 NW WALL ST STE 100, BEND, OR 97703-3200
(541) 389-4321
(541) 389-4420
Mailing address
55 NW WALL ST STE 100, BEND, OR 97703-3200
(541) 389-4321
(541) 389-4420
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
28695
OR
Other
Enumeration date
01/03/2025
Last updated
01/03/2025
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