Healthcare Provider Details

I. General information

NPI: 1144035205
Provider Name (Legal Business Name): OLIVIA CUDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W LOOP 340
WACO TX
76712-6840
US

IV. Provider business mailing address

601 W LOOP 340
WACO TX
76712-6840
US

V. Phone/Fax

Practice location:
  • Phone: 254-399-8255
  • Fax:
Mailing address:
  • Phone: 254-399-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: