Provider Demographics
NPI:1467225003
Name:AUDET, OLIVIA JEANNE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JEANNE
Last Name:AUDET
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 1:91 CAMDEN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2458
Mailing Address - Country:US
Mailing Address - Phone:207-596-0133
Mailing Address - Fax:
Practice Address - Street 1:91 CAMDEN ST STE 107
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2458
Practice Address - Country:US
Practice Address - Phone:207-596-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4504225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist