Healthcare Provider Details

I. General information

NPI: 1922216092
Provider Name (Legal Business Name): HEATHER DAWN OLIVER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 01/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14024 SE FAIROAKS WAY
MILWAUKIE OR
97267-1016
US

IV. Provider business mailing address

14024 SE FAIROAKS WAY
MILWAUKIE OR
97267-1016
US

V. Phone/Fax

Practice location:
  • Phone: 949-395-9558
  • Fax:
Mailing address:
  • Phone: 949-395-9558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1117
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number5907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: