Provider Demographics
NPI:1386380145
Name:ECKLES, AUDREY JOY (LMT)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:JOY
Last Name:ECKLES
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 1:6733 CREAMER RD
Mailing Address - Street 2:
Mailing Address - City:ORIENT
Mailing Address - State:OH
Mailing Address - Zip Code:43146-9457
Mailing Address - Country:US
Mailing Address - Phone:740-249-8836
Mailing Address - Fax:
Practice Address - Street 1:675 COOPER RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8962
Practice Address - Country:US
Practice Address - Phone:614-895-2225
Practice Address - Fax:614-895-0545
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.025799225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist