MEDICARE: LAUREN OLIVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	343717	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	343717	OTHER	NY	NBCOT

General Provider Information

NPI Number	:	1093357980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN OLIVER

Provider Business Mailing Address
First Line	:	PO BOX 1037
Second Line	:
City	:	TELLURIDE
State	:	CO
Zip	:	81435-1037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 E COLUMBIA AVE
Second Line	:
City	:	TELLURIDE
State	:	CO
Zip	:	81435-8143
Country	:	US
Telephone Number	:	518-852-0893
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	10/11/2019

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Directions to “ LAUREN OLIVER ” Practice Location

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