Individual
LORENA OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
503B RIDGE RD, MAHOMET, IL 61853-9308
(765) 562-2269
Mailing address
503B RIDGE RD, MAHOMET, IL 61853-9308
(765) 562-2269
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.003328
IL
Other
Enumeration date
08/06/2014
Last updated
08/06/2014
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