Provider Demographics
NPI:1083186795
Name:BECKETT, MICHAEL L
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:BECKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 RODEBAUGH RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9306
Mailing Address - Country:US
Mailing Address - Phone:614-604-8240
Mailing Address - Fax:
Practice Address - Street 1:8005 RODEBAUGH RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-9306
Practice Address - Country:US
Practice Address - Phone:614-604-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHG06851171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications