MEDICARE: MARIA OLAGUE PTA

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	208100000X	Physical Medicine & Rehabilitation Physician	30940	FL

General Provider Information

NPI Number	:	1285200295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA OLAGUE PTA

Provider Business Mailing Address
First Line	:	708 ILLINOIS AVE
Second Line	:
City	:	WAUCHULA
State	:	FL
Zip	:	33873-2126
Country	:	US
Telephone Number	:	863-448-3217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 US 27 N
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-2556
Country	:	US
Telephone Number	:	863-453-5200
Fax Number	:

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

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	06/01/2021

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Directions to “ MARIA OLAGUE PTA” Practice Location

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