Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0700X | Adult Development & Aging Psychologist | 606 | TN |
NPI | 1881757433 |
---|---|
Provider Name | Odacir H Oliveira |
First Address | Louisville, TN 37777-1999 |
Second Address | Louisville, TN 37777-5213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |