Provider Demographics
NPI:1184844680
Name:OLIVA, MICHELE (OTR)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:OLIVA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SEABROOK LANE
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3325
Mailing Address - Country:US
Mailing Address - Phone:631-689-6774
Mailing Address - Fax:
Practice Address - Street 1:27 SEABROOK LANE
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3325
Practice Address - Country:US
Practice Address - Phone:631-689-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010003-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist