Provider Demographics
NPI:1942743489
Name:BORDENKIRCHER, OLIVIA (LMT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BORDENKIRCHER
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 1:7700 E BUCKBOARD RD
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7467
Mailing Address - Country:US
Mailing Address - Phone:907-947-4817
Mailing Address - Fax:
Practice Address - Street 1:7700 E BUCKBOARD RD
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7467
Practice Address - Country:US
Practice Address - Phone:907-947-4817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101490225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist