Provider Demographics
NPI:1609166263
Name:O'ROURKE, OLIVIA THERESA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:THERESA
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 IONIA AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2411
Mailing Address - Country:US
Mailing Address - Phone:718-356-2236
Mailing Address - Fax:
Practice Address - Street 1:80 WOODROW RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1313
Practice Address - Country:US
Practice Address - Phone:718-356-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0153211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist