Thomas C Licklider II, CO
in Nebo, NC. Individual provider (NPI-1).
NPI number1568782860
StatusActive
Last updated in NPPESNov 4, 2011
Details
- NPI
- 1568782860
- Entity type
- Individual (NPI-1)
- Name
- Thomas C Licklider II
- Credential
- CO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 9, 2010
- Last updated
- Nov 4, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 222Z00000X | – | – | Yes |
Practice location
132 Forest Ridge DrNebo, NC 28761-8708
Phone 314-757-5395
Mailing address
132 Forest Ridge DrNebo, NC 28761-8708
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