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General NPI Number Information
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NPI Number | 1144031147
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Entity Type | Individual
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Provider Name | OLIVIA G MEDDERS
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Gender | Female
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 01/19/2025
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Provider Practice Location Address
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Address Line | 717 OLD TROLLEY RD STE 227-6
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City | SUMMERVILLE
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State | SC
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Zip | 29485-5287
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Country | US
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Telephone | 803-566-6746
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Fax |
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Provider Business Mailing Address
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Address Line | 17411 MAGNOLIA VIEW DR
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City | CLERMONT
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State | FL
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Zip | 34711-5925
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Country | US
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Telephone | 407-271-7520
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SLP.9121SPA
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License Number State | SC
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