Provider Demographics
NPI:1740061696
Name:NEWHOUSE, OLIVIA GRACE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GRACE
Last Name:NEWHOUSE
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 1:833 WASHINGTON AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-1700
Mailing Address - Country:US
Mailing Address - Phone:304-644-6548
Mailing Address - Fax:
Practice Address - Street 1:833 WASHINGTON AVE APT 4
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-1700
Practice Address - Country:US
Practice Address - Phone:304-644-6548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer