Healthcare Provider Details

I. General information

NPI: 1154469971
Provider Name (Legal Business Name): PAIN SOLUTIONS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 E KEMPER RD STE 3100B
SPRINGDALE OH
45246-3945
US

IV. Provider business mailing address

416 ALTAVIEW CT
CINCINNATI OH
45231-2701
US

V. Phone/Fax

Practice location:
  • Phone: 513-671-7246
  • Fax: 513-671-4786
Mailing address:
  • Phone: 513-671-7246
  • Fax: 513-671-4786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3319
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4825
License Number StateOH

VIII. Authorized Official

Name: DR. MERRITT S. OLESKI
Title or Position: DIRECTOR
Credential:
Phone: 513-671-7246