Healthcare Provider Details

I. General information

NPI: 1265343297
Provider Name (Legal Business Name): LORI OLOUGHLIN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 TYGART ST
FAIRMONT WV
26554-3961
US

IV. Provider business mailing address

322 TYGART ST
FAIRMONT WV
26554-3961
US

V. Phone/Fax

Practice location:
  • Phone: 304-551-7607
  • Fax:
Mailing address:
  • Phone: 304-551-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: