Healthcare Provider Details

I. General information

NPI: 1891335956
Provider Name (Legal Business Name): SAMANTHA MARIE OLIVER MA, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA MARIE GREGORY MA, ATR-BC

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 VAN BUREN DR
COLUMBUS OH
43223-7501
US

IV. Provider business mailing address

398 S GRANT AVE
COLUMBUS OH
43215-5549
US

V. Phone/Fax

Practice location:
  • Phone: 614-369-3862
  • Fax: 614-437-1557
Mailing address:
  • Phone: 614-224-2988
  • Fax: 614-716-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number15-070
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: