Healthcare Provider Details

I. General information

NPI: 1629158415
Provider Name (Legal Business Name): GALE M. OLITSKY S.A., P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD.
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

6472 PECK RD
RAVENNA OH
44266-8881
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-707-5912
Mailing address:
  • Phone: 330-298-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: