Healthcare Provider Details

I. General information

NPI: 1659286334
Provider Name (Legal Business Name): OLIVIA MARIE MCLELLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 CHANDLER ST
WORCESTER MA
01602-3441
US

IV. Provider business mailing address

61 WASHINGTON ST UNIT 61-2
WEYMOUTH MA
02188-1701
US

V. Phone/Fax

Practice location:
  • Phone: 774-250-2651
  • Fax:
Mailing address:
  • Phone: 201-485-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: