Provider Demographics
NPI:1871333146
Name:MAEDEKER, ERIC (LMT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MAEDEKER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 POSTAGE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7002
Mailing Address - Country:US
Mailing Address - Phone:614-604-6358
Mailing Address - Fax:
Practice Address - Street 1:180 POSTAGE CIR STE 100
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7002
Practice Address - Country:US
Practice Address - Phone:614-604-6358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-25
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026189225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist