Provider Demographics
NPI:1073260998
Name:VLASITY, OLIVIA LOUISE (RBT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:LOUISE
Last Name:VLASITY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 INCONNU DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4831
Mailing Address - Country:US
Mailing Address - Phone:602-821-8428
Mailing Address - Fax:
Practice Address - Street 1:171 WEBB DR STE 2
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3963
Practice Address - Country:US
Practice Address - Phone:863-270-1339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-206784106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician