MEDICARE: LORI MCNICKLE CPED, RFOM

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	224L00000X	Pedorthist	LPED32	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861733396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MCNICKLE CPED, RFOM

Provider Business Mailing Address
First Line	:	4663 WHIPPLE AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2615
Country	:	US
Telephone Number	:	330-479-0020
Fax Number	:	330-493-5759

Provider Business Practice Location Address
First Line	:	4663 WHIPPLE AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2615
Country	:	US
Telephone Number	:	330-479-0020
Fax Number	:	330-493-5759

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

Provider Enumeration Date	:	03/07/2013
Last Update Date	:	03/07/2013

Similar Medicare Providers

1174831218 — CANTON PHYSICAL MEDICARE, LLC
Practice Location Address:

2050 CUMMING HWY , SUITE 100
CANTON, GA
30114-8614

Practice Phone: 770-345-9600
Practice Fax:

1043384910 — HANGER PROSTHETICS & ORTHOTICS EAST INC
Practice Location Address:

4663 WHIPPLE AVE NW
CANTON, OH
44718-2615

Practice Phone: 330-479-0020
Practice Fax: 330-493-5759

1497096929 — JACQUELINE LAMBERT CO
Practice Location Address:

4663 WHIPPLE AVE NW
CANTON, OH
44718-2615

Practice Phone: 330-479-0020
Practice Fax: 330-493-5759

1093833097 — ANDREW MATTHEW BELTZ P.T.
Practice Location Address:

2615 TUSCARAWAS ST W
CANTON, OH
44708-4603

Practice Phone: 330-363-6215
Practice Fax: 330-363-5801

1730510215 — SARAH S LEFFLER LD
Practice Location Address:

2615 TUSCARAWAS ST W
CANTON, OH
44708-4603

Practice Phone: 330-588-4711
Practice Fax:

1821429127 — MARITA LOYOLA LD
Practice Location Address:

2615 TUSCARAWAS ST W
CANTON, OH
44708-4603

Practice Phone: 330-452-9911
Practice Fax:

Directions to “ LORI MCNICKLE CPED, RFOM” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.