Individual
MICHELE ERICSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6102 LOW RD, LISBON, OH 44432-9347
(330) 301-4595
Mailing address
PO BOX 155, ROGERS, OH 44455-0155
(330) 301-4595
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/02/2008
Last updated
09/17/2008
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