Provider Demographics
NPI:1376149682
Name:MILLINER, OLIVIA ELISE (OTD, OTR)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ELISE
Last Name:MILLINER
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 E WAYCROSS DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-5047
Mailing Address - Country:US
Mailing Address - Phone:765-717-5036
Mailing Address - Fax:
Practice Address - Street 1:7440 HAGUE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1930
Practice Address - Country:US
Practice Address - Phone:765-717-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007277A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist