Provider Demographics
NPI:1689451056
Name:JAVORSKY, OLIVER JEANNE
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:JEANNE
Last Name:JAVORSKY
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 1:27216 COOK RD TRLR 21
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1089
Mailing Address - Country:US
Mailing Address - Phone:216-970-8608
Mailing Address - Fax:
Practice Address - Street 1:6063 ROBERT DR
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2762
Practice Address - Country:US
Practice Address - Phone:216-970-8608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist