Provider Demographics
NPI:1811339864
Name:YEARICK, AUD ELAINE (LMT)
Entity type:Individual
Prefix:MRS
First Name:AUD
Middle Name:ELAINE
Last Name:YEARICK
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 1:108 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1625
Mailing Address - Country:US
Mailing Address - Phone:570-748-4505
Mailing Address - Fax:
Practice Address - Street 1:108 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1625
Practice Address - Country:US
Practice Address - Phone:570-748-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG004415225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist