Provider Demographics
NPI:1609338615
Name:OLIVER, PAULA KAE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:KAE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 JOINES RD
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:NC
Mailing Address - Zip Code:28615-8915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:312 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-1312
Practice Address - Country:US
Practice Address - Phone:828-406-1416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist