MEDICARE: LAURA OLALLO

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	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1174353882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA OLALLO

Provider Business Mailing Address
First Line	:	7408 HOLLY GROVE DR
Second Line	:
City	:	OLIVE BRANCH
State	:	MS
Zip	:	38654-1428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7408 HOLLY GROVE DR
Second Line	:
City	:	OLIVE BRANCH
State	:	MS
Zip	:	38654-1428
Country	:	US
Telephone Number	:	901-319-2963
Fax Number	:

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

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	08/06/2024

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Directions to “ LAURA OLALLO ” Practice Location

Language	Start Address	Practice Location

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