MEDICARE: MR. LARRY A DICKEY L.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	33.007690	OH

General Provider Information

NPI Number	:	1093813727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY A DICKEY L.M.T.

Provider Business Mailing Address
First Line	:	1425 S MAIN ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4245
Country	:	US
Telephone Number	:	330-499-2261
Fax Number	:	330-499-0164

Provider Business Practice Location Address
First Line	:	1425 S MAIN ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4245
Country	:	US
Telephone Number	:	330-499-2261
Fax Number	:	330-499-0164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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