Provider Demographics
NPI:1114541570
Name:OLIVERIUS, OLIVIA M
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:M
Last Name:OLIVERIUS
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 1:2 WHEATON CTR APT 2005
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2398
Mailing Address - Country:US
Mailing Address - Phone:309-635-9064
Mailing Address - Fax:
Practice Address - Street 1:2 WHEATON CTR APT 2005
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2398
Practice Address - Country:US
Practice Address - Phone:309-635-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist