Healthcare Provider Details

I. General information

NPI: 1952867442
Provider Name (Legal Business Name): KEAIRA OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 DUDLEY ST
ROXBURY MA
02119-2769
US

IV. Provider business mailing address

353 SEAVER ST
DORCHESTER MA
02121-3317
US

V. Phone/Fax

Practice location:
  • Phone: 617-989-9499
  • Fax:
Mailing address:
  • Phone: 857-234-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: