Provider Demographics
NPI:1851418842
Name:OLIVER, DONALD BRENT (MS ATC LAT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:BRENT
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MS ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-2106
Mailing Address - Country:US
Mailing Address - Phone:256-381-0506
Mailing Address - Fax:
Practice Address - Street 1:710 E 3RD ST
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-2106
Practice Address - Country:US
Practice Address - Phone:256-381-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer