Provider Demographics
NPI:1790079507
Name:OLEKSAK, KATIE BANNISH (MAC)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:BANNISH
Last Name:OLEKSAK
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CALIFORNIA ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1005
Mailing Address - Country:US
Mailing Address - Phone:617-558-1788
Mailing Address - Fax:
Practice Address - Street 1:150 CALIFORNIA ST FL 3
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1005
Practice Address - Country:US
Practice Address - Phone:617-558-1788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist