Provider Demographics
NPI:1235622069
Name:OLIVER, ANTOINETTE MICHELLE (AUD)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:MICHELLE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9300 DEWITT LOOP FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:571-231-2604
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP FL 2
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-2604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01452231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist