Provider Demographics
NPI:1417590407
Name:KIDD, OLIVIA SPILLANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:SPILLANE
Last Name:KIDD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13568 NW 1ST LN STE 1
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3698
Mailing Address - Country:US
Mailing Address - Phone:352-505-6339
Mailing Address - Fax:
Practice Address - Street 1:13568 NW 1ST LN STE 1
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-3698
Practice Address - Country:US
Practice Address - Phone:352-505-6339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20367225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist