Provider Demographics
NPI:1609394485
Name:OLECHOWSKI, VICTORIA JADE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JADE
Last Name:OLECHOWSKI
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 THOREAU WAY APT 521
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3907
Mailing Address - Country:US
Mailing Address - Phone:586-662-1973
Mailing Address - Fax:
Practice Address - Street 1:11 WINTER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:MA
Practice Address - Zip Code:01833-2029
Practice Address - Country:US
Practice Address - Phone:978-352-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33722255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer