Provider Demographics
NPI:1710182597
Name:THACKER, CATHERINE CHRISTINE (LMT)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:CHRISTINE
Last Name:THACKER
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:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:PITSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45358-0061
Mailing Address - Country:US
Mailing Address - Phone:937-533-0803
Mailing Address - Fax:
Practice Address - Street 1:115 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320
Practice Address - Country:US
Practice Address - Phone:937-533-0803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33009381225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist