Provider Demographics
NPI:1518285931
Name:MARTINO, OLIVIA A (RD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:A
Last Name:MARTINO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2469
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-2469
Mailing Address - Country:US
Mailing Address - Phone:502-852-8500
Mailing Address - Fax:502-852-8556
Practice Address - Street 1:601 S. FLOYD ST.
Practice Address - Street 2:STE. 805
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1845
Practice Address - Country:US
Practice Address - Phone:502-852-7309
Practice Address - Fax:502-852-2908
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2261133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP400018706Medicare PIN