Healthcare Provider Details

I. General information

NPI: 1073260998
Provider Name (Legal Business Name): OLIVIA LOUISE CHANICKA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2243 NORTH BLVD W
DAVENPORT FL
33837-8990
US

IV. Provider business mailing address

33 INCONNU DR
KISSIMMEE FL
34759-4831
US

V. Phone/Fax

Practice location:
  • Phone: 863-270-1339
  • Fax:
Mailing address:
  • Phone: 602-821-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2851770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: