Provider Demographics
NPI:1841746161
Name:OLEWILER, SAMUEL ROBERT (AT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:ROBERT
Last Name:OLEWILER
Suffix:
Gender:M
Credentials:AT
Other - Prefix:MR
Other - First Name:SAMUEL
Other - Middle Name:ROBERT
Other - Last Name:OLEWILER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AT
Mailing Address - Street 1:169 WEST UNION STREET
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-593-1636
Mailing Address - Fax:
Practice Address - Street 1:1 OHIO UNIVERSITY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-593-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer