Healthcare Provider Details

I. General information

NPI: 1346025897
Provider Name (Legal Business Name): OLIVIA DYER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLIVIA MAURER

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4285 DEVELOPMENT DR
LANSING MI
48911-4213
US

IV. Provider business mailing address

210 FLORAL AVE
SAINT JOHNS MI
48879-1048
US

V. Phone/Fax

Practice location:
  • Phone: 517-706-0421
  • Fax:
Mailing address:
  • Phone: 517-388-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201013589
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: