MEDICARE: MRS. EVELYN PATRICIA OLIVER CRT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2278C0205X	Critical Care Certified Respiratory Therapist	1426	AL

General Provider Information

NPI Number	:	1316961212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EVELYN PATRICIA OLIVER CRT

Provider Business Mailing Address
First Line	:	14416 TIMBER RIDGE DR
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39562-8790
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14416 TIMBER RIDGE DR
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39562-8790
Country	:	US
Telephone Number	:	228-474-6065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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