Provider Demographics
NPI:1841876612
Name:WITHERITE, OLIVIA (ATC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:WITHERITE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 WORTH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15851-1716
Mailing Address - Country:US
Mailing Address - Phone:814-227-7865
Mailing Address - Fax:
Practice Address - Street 1:1544 WORTH STREET EXT
Practice Address - Street 2:
Practice Address - City:REYNOLDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15851-1716
Practice Address - Country:US
Practice Address - Phone:814-227-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer