Provider Demographics
NPI:1992472948
Name:ANDERS, OLIVIA AUTUMN
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:AUTUMN
Last Name:ANDERS
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 1:800 ENERGY CENTER BLVD APT 2413
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-2724
Mailing Address - Country:US
Mailing Address - Phone:256-502-1228
Mailing Address - Fax:
Practice Address - Street 1:4051 E OLIVE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6487
Practice Address - Country:US
Practice Address - Phone:850-972-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18368224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant