Provider Demographics
NPI:1326565672
Name:RICKEY, NATHAN PHILIP
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:PHILIP
Last Name:RICKEY
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 1:7227 RADFORD RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-9219
Mailing Address - Country:US
Mailing Address - Phone:740-707-2571
Mailing Address - Fax:
Practice Address - Street 1:1 OHIO UNIVERSITY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2942
Practice Address - Country:US
Practice Address - Phone:740-594-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer