MEDICARE: OLGA HOUSEHOLDER

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1952942252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA HOUSEHOLDER

Provider Business Mailing Address
First Line	:	PO BOX 12189
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97309-0189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 SW HILL RD
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-9133
Country	:	US
Telephone Number	:	503-435-3404
Fax Number	:

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

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	10/08/2019

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Directions to “ OLGA HOUSEHOLDER ” Practice Location

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