Provider Demographics
NPI:1285155358
Name:DECKER, LILLIAN (LMT)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LILLEY
Other - Middle Name:
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1818 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2709
Mailing Address - Country:US
Mailing Address - Phone:419-463-2559
Mailing Address - Fax:
Practice Address - Street 1:360 RICE ST
Practice Address - Street 2:
Practice Address - City:ELMORE
Practice Address - State:OH
Practice Address - Zip Code:43416-9422
Practice Address - Country:US
Practice Address - Phone:419-463-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022222225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH022222OtherLICENSED MASSAGE THERAPIST