Provider Demographics
NPI:1174181937
Name:TACKETT, CINDY LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LYNN
Last Name:TACKETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3166 BEECH RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-9458
Mailing Address - Country:US
Mailing Address - Phone:513-509-6644
Mailing Address - Fax:
Practice Address - Street 1:131 N POINT DR
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-8366
Practice Address - Country:US
Practice Address - Phone:937-444-1166
Practice Address - Fax:888-757-7699
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist