Healthcare Provider Details

I. General information

NPI: 1902072648
Provider Name (Legal Business Name): VALERIE L OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VALERIE L RUONALA

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 MAIN ST
NORTH MYRTLE BEACH SC
29582-3023
US

IV. Provider business mailing address

423 MAIN ST
NORTH MYRTLE BEACH SC
29582-3023
US

V. Phone/Fax

Practice location:
  • Phone: 843-249-2722
  • Fax:
Mailing address:
  • Phone: 843-249-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFTS0480
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: