MEDICARE: OLIVIA OLDHAM

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1588445928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA OLDHAM

Provider Business Mailing Address
First Line	:	30903 W 10 MILE RD STE B
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-2615
Country	:	US
Telephone Number	:	248-893-6192
Fax Number	:	248-457-5490

Provider Business Practice Location Address
First Line	:	675 E BIG BEAVER RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1418
Country	:	US
Telephone Number	:	248-817-2484
Fax Number	:	248-457-5490

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

Provider Enumeration Date	:	10/11/2023
Last Update Date	:	10/11/2023

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Directions to “ OLIVIA OLDHAM ” Practice Location

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