Provider Demographics
NPI:1568644243
Name:DICKENHERR, MARY S (LMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:DICKENHERR
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 1:3785 CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2752
Mailing Address - Country:US
Mailing Address - Phone:513-368-0891
Mailing Address - Fax:
Practice Address - Street 1:10653 TECHWOOD CIR
Practice Address - Street 2:STE 101
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-2833
Practice Address - Country:US
Practice Address - Phone:513-956-3200
Practice Address - Fax:513-956-3202
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.010021225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist