Provider Demographics
NPI:1710510219
Name:OLIVA, MARYBETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:OLIVA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 FAIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3722
Mailing Address - Country:US
Mailing Address - Phone:903-258-2888
Mailing Address - Fax:
Practice Address - Street 1:370 S STATE HIGHWAY 121 N STE 105
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4265
Practice Address - Country:US
Practice Address - Phone:817-479-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115006225XP0200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics