Provider Demographics
NPI:1851021125
Name:NEVILLE, OLIVIA DENALI (LMT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:DENALI
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 CROWN HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTER CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03813-4724
Mailing Address - Country:US
Mailing Address - Phone:253-380-0274
Mailing Address - Fax:
Practice Address - Street 1:87 MECHANIC ST.
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-0386
Practice Address - Country:US
Practice Address - Phone:253-380-0274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7866225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist