Provider Demographics
NPI:1063787554
Name:HICKS, BARBARA (LMT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 OAK ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-2087
Mailing Address - Country:US
Mailing Address - Phone:541-386-4774
Mailing Address - Fax:
Practice Address - Street 1:508 OAK ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2087
Practice Address - Country:US
Practice Address - Phone:541-386-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3918225700000X
WAMA 00005964225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist