Provider Demographics
NPI:1225682479
Name:OELSLAGER, LYDIA KASEY
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:KASEY
Last Name:OELSLAGER
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 1:6614 REAFIELD DR APT 17
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3597
Mailing Address - Country:US
Mailing Address - Phone:910-262-8594
Mailing Address - Fax:
Practice Address - Street 1:6614 REAFIELD DR APT 17
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3597
Practice Address - Country:US
Practice Address - Phone:910-262-8594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician