Healthcare Provider Details

I. General information

NPI: 1053195958
Provider Name (Legal Business Name): OLIVIA MORGENTHALER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 PARKWAY CIR STE 100
SPRINGDALE AR
72762-5328
US

IV. Provider business mailing address

3901 SW RICHSMITH RD APT 303
BENTONVILLE AR
72713-3045
US

V. Phone/Fax

Practice location:
  • Phone: 479-249-9417
  • Fax: 479-587-1366
Mailing address:
  • Phone: 479-249-9417
  • Fax: 479-587-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9163
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: