Provider Demographics
NPI:1902461734
Name:OLIVER, ALI L
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:L
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 OAK ST STE D
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4088
Mailing Address - Country:US
Mailing Address - Phone:541-600-4623
Mailing Address - Fax:458-209-3218
Practice Address - Street 1:1639 OAK ST STE D
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4088
Practice Address - Country:US
Practice Address - Phone:541-600-4623
Practice Address - Fax:458-209-3218
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24978225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist