Provider Demographics
NPI:1164848230
Name:CARVER, OLLIE X (LMT)
Entity Type:Individual
Prefix:
First Name:OLLIE
Middle Name:
Last Name:CARVER
Suffix:X
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4128 E 175TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2224
Mailing Address - Country:US
Mailing Address - Phone:216-991-3922
Mailing Address - Fax:216-991-3922
Practice Address - Street 1:4128 E 175TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2224
Practice Address - Country:US
Practice Address - Phone:216-991-3922
Practice Address - Fax:216-991-3922
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33004579225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist