Provider Demographics
NPI:1578259578
Name:LEWIS, OLIVIA ILENE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ILENE
Last Name:LEWIS
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 1:206 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49252-9737
Mailing Address - Country:US
Mailing Address - Phone:517-200-8518
Mailing Address - Fax:
Practice Address - Street 1:23 OXBOW TRL
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-6809
Practice Address - Country:US
Practice Address - Phone:740-593-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer