MEDICARE: JULIA CHICK

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	33.025108	OH

General Provider Information

NPI Number	:	1881279065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA CHICK

Provider Business Mailing Address
First Line	:	5898 OPAL ST
Second Line	:
City	:	N RIDGEVILLE
State	:	OH
Zip	:	44039-2032
Country	:	US
Telephone Number	:	458-321-4188
Fax Number	:

Provider Business Practice Location Address
First Line	:	14520 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4317
Country	:	US
Telephone Number	:	845-321-4188
Fax Number	:

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

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	03/10/2021

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Directions to “ JULIA CHICK ” Practice Location

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