Provider Demographics
NPI:1922216092
Name:OLIVER, HEATHER DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14024 SE FAIROAKS WAY
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-1016
Mailing Address - Country:US
Mailing Address - Phone:949-395-9558
Mailing Address - Fax:
Practice Address - Street 1:14024 SE FAIROAKS WAY
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-1016
Practice Address - Country:US
Practice Address - Phone:949-395-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1117225700000X
CA5907173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist