Individual
LORI MCNICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPED, RFOM
Contact information
Practice address
4663 WHIPPLE AVE NW, CANTON, OH 44718-2615
(330) 479-0020
(330) 493-5759
Mailing address
4663 WHIPPLE AVE NW, CANTON, OH 44718-2615
(330) 479-0020
(330) 493-5759
Taxonomy
Speciality
Code
Description
License number
State
224L00000X
Pedorthist
Primary
LPED32
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2002862
—
OH
Enumeration date
03/07/2013
Last updated
03/07/2013
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