Provider Demographics
NPI:1346674991
Name:STAIR, RICKY LEE (LMT)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:LEE
Last Name:STAIR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:146 E LIBERTY ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-4371
Mailing Address - Country:US
Mailing Address - Phone:330-466-2164
Mailing Address - Fax:330-754-1373
Practice Address - Street 1:146 E LIBERTY ST
Practice Address - Street 2:SUITE 160
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4371
Practice Address - Country:US
Practice Address - Phone:330-466-2164
Practice Address - Fax:330-754-1373
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.014165S225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist