Provider Demographics
NPI:1346786092
Name:OLINI, KATIE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:OLINI
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3827 MAYPOP CIR
Mailing Address - Street 2:UNIT 317
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-1407
Mailing Address - Country:US
Mailing Address - Phone:732-778-2153
Mailing Address - Fax:
Practice Address - Street 1:3302 ROBERT M GRISSOM PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-6401
Practice Address - Country:US
Practice Address - Phone:843-445-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20112255A2300X
NJ25MT002143002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer