Provider Demographics
NPI:1760231898
Name:OLIVE & MAGNOLIA OCCUPATIONAL THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:OLIVE & MAGNOLIA OCCUPATIONAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT; BUSINESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AISLINN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:678-758-9127
Mailing Address - Street 1:3788 NE 4TH ST APT J308
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-8484
Mailing Address - Country:US
Mailing Address - Phone:678-758-9127
Mailing Address - Fax:
Practice Address - Street 1:3788 NE 4TH ST APT J308
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-8484
Practice Address - Country:US
Practice Address - Phone:678-758-9127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty