Healthcare Provider Details

I. General information

NPI: 1417880154
Provider Name (Legal Business Name): WITHLINE OLIBRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15218 UNION TPKE APT 9C
FLUSHING NY
11367-3925
US

IV. Provider business mailing address

15218 UNION TPKE APT 9C
FLUSHING NY
11367-3925
US

V. Phone/Fax

Practice location:
  • Phone: 239-777-8750
  • Fax:
Mailing address:
  • Phone: 239-777-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number031095
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: