Provider Demographics
NPI:1356097638
Name:BENGTSON, OLIVIA J
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:J
Last Name:BENGTSON
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 1:19 GRAND OAK RD
Mailing Address - Street 2:
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644-1203
Mailing Address - Country:US
Mailing Address - Phone:508-776-3691
Mailing Address - Fax:
Practice Address - Street 1:19 GRAND OAK RD
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:MA
Practice Address - Zip Code:02644-1203
Practice Address - Country:US
Practice Address - Phone:508-776-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist