Provider Demographics
NPI:1619264975
Name:OLIVER, TAMIKA A
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:A
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 RED OAK LN
Mailing Address - Street 2:UNIT 4
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60484-2931
Mailing Address - Country:US
Mailing Address - Phone:708-534-5725
Mailing Address - Fax:
Practice Address - Street 1:723 RED OAK LN
Practice Address - Street 2:UNIT 4
Practice Address - City:UNIVERSITY PARK
Practice Address - State:IL
Practice Address - Zip Code:60484-2931
Practice Address - Country:US
Practice Address - Phone:708-534-5725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist