Provider Demographics
NPI:1841076924
Name:MAZZA, OLIVIA MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIE
Last Name:MAZZA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ARMETALE LUSTER
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2472
Mailing Address - Country:US
Mailing Address - Phone:585-645-9346
Mailing Address - Fax:
Practice Address - Street 1:115 CONTINUUM DR
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4387
Practice Address - Country:US
Practice Address - Phone:315-450-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028345225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist