Provider Demographics
NPI:1699502005
Name:OLIVER, KAYLYNN LILLIAN
Entity type:Individual
Prefix:MRS
First Name:KAYLYNN
Middle Name:LILLIAN
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 1:616 W MAIN ST STE G
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1780
Mailing Address - Country:US
Mailing Address - Phone:540-731-4327
Mailing Address - Fax:540-731-4328
Practice Address - Street 1:616 W MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1780
Practice Address - Country:US
Practice Address - Phone:540-731-4327
Practice Address - Fax:540-731-4328
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
144131562355A2700X
VA2101002829237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant