Provider Demographics
NPI:1447504584
Name:SPIKES, LYNNICE MICHELE (LMT)
Entity type:Individual
Prefix:
First Name:LYNNICE
Middle Name:MICHELE
Last Name:SPIKES
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 1:591 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-4343
Mailing Address - Country:US
Mailing Address - Phone:440-352-7367
Mailing Address - Fax:
Practice Address - Street 1:591 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-4343
Practice Address - Country:US
Practice Address - Phone:440-352-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-020193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist