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General NPI Number Information
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NPI Number | 1992472948
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Entity Type | Individual
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Provider Name | OLIVIA AUTUMN ANDERS
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Gender | Female
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 4051 E OLIVE RD
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City | PENSACOLA
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State | FL
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Zip | 32514-6487
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Country | US
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Telephone | 850-972-2876
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Fax |
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Provider Business Mailing Address
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Address Line | 800 ENERGY CENTER BLVD APT 2413
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City | NORTHPORT
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State | AL
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Zip | 35473-2724
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Country | US
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Telephone | 256-502-1228
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA18368
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License Number State | FL
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