Provider Demographics
NPI:1164180402
Name:JAMES, OLYMPIA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:OLYMPIA
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6518 SPRING BROOK AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-3713
Mailing Address - Country:US
Mailing Address - Phone:845-625-8098
Mailing Address - Fax:
Practice Address - Street 1:250 TUYTENBRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5429
Practice Address - Country:US
Practice Address - Phone:845-336-7235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist