Healthcare Provider Details

I. General information

NPI: 1134058746
Provider Name (Legal Business Name): OLIVIA RAE CZARNOMSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 PARKMOOR DR
WESTERVILLE OH
43082-8837
US

IV. Provider business mailing address

890 NORWEGIAN WOOD DR
MEDINA OH
44256-3519
US

V. Phone/Fax

Practice location:
  • Phone: 614-519-6001
  • Fax:
Mailing address:
  • Phone: 330-662-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: