Healthcare Provider Details

I. General information

NPI: 1629844899
Provider Name (Legal Business Name): OLIVIA WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 N LIMESTONE ST
SPRINGFIELD OH
45503-2648
US

IV. Provider business mailing address

80 JAN CT
FAIRBORN OH
45324-2510
US

V. Phone/Fax

Practice location:
  • Phone: 937-910-6220
  • Fax: 800-480-7578
Mailing address:
  • Phone: 937-248-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: