MEDICARE: DONNA MICHELLE OLIVER MASSAGE THERAPIST

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	225700000X	Massage Therapist	109686	KY

General Provider Information

NPI Number	:	1336645951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA MICHELLE OLIVER MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	5129 DIXIE HWY STE 105
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-1729
Country	:	US
Telephone Number	:	502-272-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	5129 DIXIE HWY STE 105
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-1729
Country	:	US
Telephone Number	:	502-272-4700
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	04/03/2018

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