Provider Demographics
NPI:1629191101
Name:OLIVER, MARCIA E (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:E
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MARCIA
Other - Middle Name:E
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:5600 OAK RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47868-7050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5600 OAK RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:IN
Practice Address - Zip Code:47868-7050
Practice Address - Country:US
Practice Address - Phone:765-795-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2012-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007635A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist