MEDICARE: MAKAYLA 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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1649744574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKAYLA OLIVER

Provider Business Mailing Address
First Line	:	PO BOX 2677
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-2677
Country	:	US
Telephone Number	:	402-214-4407
Fax Number	:

Provider Business Practice Location Address
First Line	:	12812 OLD GLENN HWY STE A3
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7003
Country	:	US
Telephone Number	:	907-317-5895
Fax Number	:

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

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	05/09/2021

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