Provider Demographics
NPI:1922204122
Name:HICKS, JUDITH (OTR)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:CLAIRE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:5020 KEY WEST DR
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-5925
Mailing Address - Country:US
Mailing Address - Phone:937-829-0557
Mailing Address - Fax:
Practice Address - Street 1:5020 KEY WEST DR
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-5925
Practice Address - Country:US
Practice Address - Phone:937-829-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000320174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist