MEDICARE: VALERIE L 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	225000000X	Orthotic Fitter	CFTS0480	SC

General Provider Information

NPI Number	:	1902072648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE L OLIVER

Provider Business Mailing Address
First Line	:	423 MAIN ST
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3023
Country	:	US
Telephone Number	:	843-249-2722
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 MAIN ST
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3023
Country	:	US
Telephone Number	:	843-249-2722
Fax Number	:

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

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	05/02/2008

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Directions to “ VALERIE L OLIVER ” Practice Location

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