Provider Demographics
NPI:1891420758
Name:RUDD, OLIVIA MARIE
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:MARIE
Last Name:RUDD
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 1:777 WOODROW AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6035
Mailing Address - Country:US
Mailing Address - Phone:174-036-1741
Mailing Address - Fax:
Practice Address - Street 1:777 WOODROW AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6035
Practice Address - Country:US
Practice Address - Phone:174-036-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist