MEDICARE: AMANDA OLIVE

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	2355S0801X	Speech-Language Assistant		NC

General Provider Information

NPI Number	:	1780517011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA OLIVE

Provider Business Mailing Address
First Line	:	2180 G AND A LN
Second Line	:
City	:	GRANITE FALLS
State	:	NC
Zip	:	28630-8923
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	924 MAIN ST STE 350
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-4282
Country	:	US
Telephone Number	:	336-566-6104
Fax Number	:

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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Directions to “ AMANDA OLIVE ” Practice Location

Language	Start Address	Practice Location

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