Provider Demographics
NPI:1164590444
Name:TALERICO-HICKEL, CICILY R (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CICILY
Middle Name:R
Last Name:TALERICO-HICKEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:CICILY
Other - Middle Name:R
Other - Last Name:TALERICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:713 COSBY RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-1421
Mailing Address - Country:US
Mailing Address - Phone:315-792-1884
Mailing Address - Fax:
Practice Address - Street 1:241 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-3401
Practice Address - Country:US
Practice Address - Phone:315-272-1606
Practice Address - Fax:315-272-1780
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013118-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist