Provider Demographics
NPI:1285214809
Name:MASTRANGELI, OLIVIA C (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:C
Last Name:MASTRANGELI
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906F W BROAD ST STE F
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-5803
Mailing Address - Country:US
Mailing Address - Phone:804-351-5824
Mailing Address - Fax:844-600-2797
Practice Address - Street 1:8906F W BROAD ST STE F
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-5803
Practice Address - Country:US
Practice Address - Phone:804-351-5824
Practice Address - Fax:844-600-2797
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist