Healthcare Provider Details

I. General information

NPI: 1861329195
Provider Name (Legal Business Name): COLLEEN EIDEMILLER LMT,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 W MAIN ST FRNT DOOR
TIPP CITY OH
45371-3326
US

IV. Provider business mailing address

3281 W STATE ROUTE 571
TROY OH
45373-7521
US

V. Phone/Fax

Practice location:
  • Phone: 937-266-9756
  • Fax: 937-848-1926
Mailing address:
  • Phone: 937-266-9756
  • Fax: 937-848-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN EIDEMILLER
Title or Position: OWNER
Credential: LMT
Phone: 937-266-9756