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NPI Code Detail

MEDICARE: AMANDA CHRISTINE OLIVER MSOT, OTR/L

MEDICARE: AMANDA CHRISTINE OLIVER MSOT, OTR/L
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
1225XP0200XPediatric Occupational TherapistOT-2654NV

General Provider Information

NPI Number : 1144819350
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA CHRISTINE OLIVER MSOT, OTR/L
Provider Business Mailing Address
First Line : 8020 CRACKER BARREL ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89143-5184
Country : US
Telephone Number : 702-241-8289
Fax Number :
Provider Business Practice Location Address
First Line : 7541 TULE SPRINGS RD UNIT 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89131-8303
Country : US
Telephone Number : 702-360-1137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2021
Last Update Date : 01/12/2021

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