Healthcare Provider Details

I. General information

NPI: 1497513667
Provider Name (Legal Business Name): OLINA MALLORY BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLINA HELTON

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 INDUSTRIAL DR
OWOSSO MI
48867-9775
US

IV. Provider business mailing address

1555 INDUSTRIAL DR
OWOSSO MI
48867-9775
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-6791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: