Provider Demographics
NPI:1073903498
Name:LITOVSKY, OLENA
Entity Type:Individual
Prefix:
First Name:OLENA
Middle Name:
Last Name:LITOVSKY
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 1:5520 S VAN WINKLE EXPY
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7324
Mailing Address - Country:US
Mailing Address - Phone:801-467-3529
Mailing Address - Fax:801-883-9898
Practice Address - Street 1:1898 E VINTAGE WOODS CT
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-7029
Practice Address - Country:US
Practice Address - Phone:801-915-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59011024701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist