Provider Demographics
NPI:1487976395
Name:KLICKER, THOMAS JACOB (LMP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JACOB
Last Name:KLICKER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6734 W 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2544
Mailing Address - Country:US
Mailing Address - Phone:509-416-6540
Mailing Address - Fax:509-491-3757
Practice Address - Street 1:6734 W 31ST AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2544
Practice Address - Country:US
Practice Address - Phone:509-416-6540
Practice Address - Fax:509-491-3757
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60043015225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist