Individual
BENJAMIN TILDON HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
7 CRATER LAKE AVE, MEDFORD, OR 97504-7466
(541) 613-3787
Mailing address
1888 WILLOW GLEN WAY, MEDFORD, OR 97504-5709
(541) 613-3787
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
023488
OR
Other
Enumeration date
03/08/2023
Last updated
03/08/2023
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