MEDICARE: OLIVIA DENALI NEVILLE LMT

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	7866	NH

General Provider Information

NPI Number	:	1851021125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA DENALI NEVILLE LMT

Provider Business Mailing Address
First Line	:	265 CROWN HILL RD
Second Line	:
City	:	CENTER CONWAY
State	:	NH
Zip	:	03813-4724
Country	:	US
Telephone Number	:	253-380-0274
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 MECHANIC ST.
Second Line	:
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-0386
Country	:	US
Telephone Number	:	253-380-0274
Fax Number	:

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

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	06/10/2022

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