MEDICARE: MRS. LETITIA OLIVER LMT

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	225700000X	Massage Therapist	MA89540	FL

General Provider Information

NPI Number	:	1528608981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LETITIA OLIVER LMT

Provider Business Mailing Address
First Line	:	1009 BLUFFTON DR
Second Line	:
City	:	BAINBRIDGE
State	:	GA
Zip	:	39817-8390
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1534 DAWSON RD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3437
Country	:	US
Telephone Number	:	229-205-0226
Fax Number	:

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

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/13/2020

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