Provider Demographics
NPI:1194794479
Name:OLIVER, MARIANNE CECELIA (PT)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:CECELIA
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5462 BANEBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-7398
Mailing Address - Country:US
Mailing Address - Phone:614-326-0347
Mailing Address - Fax:
Practice Address - Street 1:1151 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2827
Practice Address - Country:US
Practice Address - Phone:614-559-0229
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist