Provider Demographics
NPI:1811762255
Name:PLAZA, OLIVIA (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:
Last Name:PLAZA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MOUNT EBO RD S
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4092
Mailing Address - Country:US
Mailing Address - Phone:845-940-1810
Mailing Address - Fax:
Practice Address - Street 1:3514 E MAIN RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-9721
Practice Address - Country:US
Practice Address - Phone:716-410-3906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist