Healthcare Provider Details

I. General information

NPI: 1073866448
Provider Name (Legal Business Name): LILY M OLIVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 US HIGHWAY 27 NORTH
SEBRING FL
33870
US

IV. Provider business mailing address

6200 E ARBUCKLE RD
AVON PARK FL
33825-8213
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-5656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4888
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: