MEDICARE: GRACE 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	172A00000X	Driver

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447835483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE OLIVER

Provider Business Mailing Address
First Line	:	6130 IRON ROCK ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-3228
Country	:	US
Telephone Number	:	832-687-0486
Fax Number	:	713-929-3572

Provider Business Practice Location Address
First Line	:	5831 LE CARPE PLANTATION CT
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-5373
Country	:	US
Telephone Number	:	832-687-0486
Fax Number	:	713-929-3572

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

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	03/11/2021

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Directions to “ GRACE OLIVER ” Practice Location

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