Provider Demographics
NPI:1073717435
Name:BRICKER, SANDRA KAY (LAT ATC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KAY
Last Name:BRICKER
Suffix:
Gender:F
Credentials:LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2689 JOSEPH STR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1809
Mailing Address - Country:US
Mailing Address - Phone:440-937-5286
Mailing Address - Fax:
Practice Address - Street 1:2689 JOSEPH ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1909
Practice Address - Country:US
Practice Address - Phone:440-937-5286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer