Provider Demographics
NPI:1952324196
Name:OLIVER, CODI C (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:CODI
Middle Name:C
Last Name:OLIVER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-1379
Mailing Address - Country:US
Mailing Address - Phone:479-524-8028
Mailing Address - Fax:479-524-6151
Practice Address - Street 1:1675 W. JEFFERSON
Practice Address - Street 2:STE A
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761
Practice Address - Country:US
Practice Address - Phone:479-524-8028
Practice Address - Fax:479-524-6151
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1488225X00000X
AROTR2061225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1488OtherSTATE LICENSE
AROTR2061OtherARKANSAS STATE MEDICAL BO