Provider Demographics
NPI:1841778412
Name:OLIU-SMITH, DAWN M
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:OLIU-SMITH
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 1:419 VALENCIA PARK DR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-5497
Mailing Address - Country:US
Mailing Address - Phone:813-654-1484
Mailing Address - Fax:
Practice Address - Street 1:419 VALENCIA PARK DR
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-5497
Practice Address - Country:US
Practice Address - Phone:813-310-6591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-05
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28639225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant