Provider Demographics
NPI:1396490033
Name:OLIVERA, ARIEL JOSE (OTA)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:JOSE
Last Name:OLIVERA
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SUMMERWIND LN
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1867
Mailing Address - Country:US
Mailing Address - Phone:239-677-5326
Mailing Address - Fax:
Practice Address - Street 1:200 SUMMERWIND LN
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1867
Practice Address - Country:US
Practice Address - Phone:239-677-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
PAOP010209224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant