Provider Demographics
NPI:1295225746
Name:WHATTON, OLIVIA HOLLIS
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:HOLLIS
Last Name:WHATTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:ASHLEY
Other - Last Name:HOLLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 S CRESTMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2736
Mailing Address - Country:US
Mailing Address - Phone:502-544-3383
Mailing Address - Fax:
Practice Address - Street 1:2616 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2604
Practice Address - Country:US
Practice Address - Phone:502-451-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist