MEDICARE: JULIANNE OLDS BA, COTA/L, AHA

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	359830	FL

General Provider Information

NPI Number	:	1770111726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNE OLDS BA, COTA/L, AHA

Provider Business Mailing Address
First Line	:	4821 MYRTLE OAK DR UNIT 12
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-5319
Country	:	US
Telephone Number	:	727-992-6814
Fax Number	:

Provider Business Practice Location Address
First Line	:	4821 MYRTLE OAK DR UNIT 12
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-5319
Country	:	US
Telephone Number	:	727-992-6814
Fax Number	:

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

Provider Enumeration Date	:	03/27/2020
Last Update Date	:	03/27/2020

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