Healthcare Provider Details

I. General information

NPI: 1932572138
Provider Name (Legal Business Name): ASHLEY OLIVER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 N ARLINGTON AVE
INDIANAPOLIS IN
46226-2401
US

IV. Provider business mailing address

307 N ODELL ST
BROWNSBURG IN
46112-2123
US

V. Phone/Fax

Practice location:
  • Phone: 317-822-7980
  • Fax:
Mailing address:
  • Phone: 219-309-0479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002318A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: