Provider Demographics
NPI:1508538836
Name:OLIVER, CHAD RYAN
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:RYAN
Last Name:OLIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 S COOPER ST STE 144
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4100
Mailing Address - Country:US
Mailing Address - Phone:817-466-4327
Mailing Address - Fax:
Practice Address - Street 1:3810 S COOPER ST STE 144
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4100
Practice Address - Country:US
Practice Address - Phone:817-466-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80987237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist