Provider Demographics
NPI:1538980826
Name:OLIVE BRANCH TOTAL WELLNESS LLC
Entity type:Organization
Organization Name:OLIVE BRANCH TOTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPICER-THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-223-9161
Mailing Address - Street 1:281 SARATOGA BLVD E
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8282
Mailing Address - Country:US
Mailing Address - Phone:973-807-8790
Mailing Address - Fax:
Practice Address - Street 1:281 SARATOGA BLVD E
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8282
Practice Address - Country:US
Practice Address - Phone:973-807-8790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care