Provider Demographics
NPI:1073913141
Name:NEIWIRTH, OLIVIA FAYE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:FAYE
Last Name:NEIWIRTH
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 1:501 SE 2ND ST APT 1216
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3681
Mailing Address - Country:US
Mailing Address - Phone:954-258-8340
Mailing Address - Fax:
Practice Address - Street 1:501 SE 2ND ST APT 1216
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3681
Practice Address - Country:US
Practice Address - Phone:954-258-8340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9123235Z00000X
FLSA14497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist