Healthcare Provider Details

I. General information

NPI: 1013632165
Provider Name (Legal Business Name): AVERY MARIE OLMSTEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 ABRAMS RD STE 112
DALLAS TX
75214-2000
US

IV. Provider business mailing address

5510 ABRAMS RD STE 112
DALLAS TX
75214-2000
US

V. Phone/Fax

Practice location:
  • Phone: 214-846-0579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: