Provider Demographics
NPI:1922797083
Name:OLAN, MARY ANGELA DACANAY
Entity Type:Individual
Prefix:
First Name:MARY ANGELA
Middle Name:DACANAY
Last Name:OLAN
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 1:2145 W FREDERICK DR APT A
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2360
Mailing Address - Country:US
Mailing Address - Phone:765-427-2531
Mailing Address - Fax:
Practice Address - Street 1:2145 W FREDERICK DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2360
Practice Address - Country:US
Practice Address - Phone:765-427-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045603225100000X
IN05014950A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist