Individual
THOMAS C LICKLIDER II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CO
Contact information
Practice address
132 FOREST RIDGE DR, NEBO, NC 28761-8708
(314) 757-5395
Mailing address
132 FOREST RIDGE DR, NEBO, NC 28761-8708
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
Other
Enumeration date
06/09/2010
Last updated
11/04/2011
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