Healthcare Provider Details

I. General information

NPI: 1689613549
Provider Name (Legal Business Name): CHRISTINA MARIE OLEVANO BSPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 STATE ROUTE 38
OWEGO NY
13827-0120
US

IV. Provider business mailing address

1062 STATE ROUTE 38
OWEGO NY
13827-0120
US

V. Phone/Fax

Practice location:
  • Phone: 607-687-8610
  • Fax:
Mailing address:
  • Phone: 607-687-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number005937
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: