Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA-31267 | FL |
NPI | 1003803750 |
---|---|
Provider Name | Ms. Lisa M Olivero |
First Address | Ormond Beach, FL 32174-8501 |
Second Address | Ormond Beach, FL 32174-8501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C2727 | BCBS - MASSAGE THERAPY (01) | FL |