MEDICARE: EMILY GRACE OLIVER

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	OT26980	FL

General Provider Information

NPI Number	:	1871441626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY GRACE OLIVER

Provider Business Mailing Address
First Line	:	11504 CYPRESS RESERVE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1335
Country	:	US
Telephone Number	:	813-951-0141
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4530
Country	:	US
Telephone Number	:	850-763-0446
Fax Number	:

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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