Provider Demographics
NPI:1295556330
Name:ROBERTS, OLIVIA SUSAN
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:SUSAN
Last Name:ROBERTS
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 1:4088 PRESERVE RUN CIR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-6431
Mailing Address - Country:US
Mailing Address - Phone:330-636-1956
Mailing Address - Fax:
Practice Address - Street 1:4088 PRESERVE RUN CIR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-6431
Practice Address - Country:US
Practice Address - Phone:330-636-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach