Provider Demographics
NPI:1275833303
Name:HICKEY, KERI ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:ANN
Last Name:HICKEY
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 1:1 PILLING RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-1415
Mailing Address - Country:US
Mailing Address - Phone:978-604-7353
Mailing Address - Fax:
Practice Address - Street 1:1 PILLING RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-1415
Practice Address - Country:US
Practice Address - Phone:978-604-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225700000X225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist