Healthcare Provider Details

I. General information

NPI: 1427987684
Provider Name (Legal Business Name): RICKI MCMILLIN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1754 COMMERCE CENTER BLVD
FAIRBORN OH
45324-6358
US

IV. Provider business mailing address

4736 SULLIVAN RD
SPRINGFIELD OH
45502-8189
US

V. Phone/Fax

Practice location:
  • Phone: 937-414-9454
  • Fax:
Mailing address:
  • Phone: 937-416-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.026506
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: