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General NPI Number Information
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NPI Number | 1013845536
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Entity Type | Individual
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Provider Name | OCTAVIA TRICE
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Gender | Female
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Dates
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Enumeration Date | 05/13/2026
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Last Update Date | 05/13/2026
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Provider Practice Location Address
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Address Line | 1011 SOUTH DR
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City | INDIANA
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State | PA
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Zip | 15705-1046
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Country | US
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Telephone | 724-357-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 744 SOUTH ST
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City | INDIANA
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State | PA
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Zip | 15701-2939
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Country | US
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Telephone | 814-961-4924
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | PA
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