Healthcare Provider Details

I. General information

NPI: 1588869457
Provider Name (Legal Business Name): LISA CHRISTINE OLVERA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5471 SCIOTO DARBY RD
HILLIARD OH
43026-1310
US

IV. Provider business mailing address

5471 SCIOTO DARBY RD
HILLIARD OH
43026-1310
US

V. Phone/Fax

Practice location:
  • Phone: 614-876-7356
  • Fax: 614-529-7121
Mailing address:
  • Phone: 614-876-7356
  • Fax: 614-529-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT5835
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: