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General NPI Number Information
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NPI Number | 1235116906
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Entity Type | Individual
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Provider Name | TERRENCE M OLITSKY PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4804 LEAVITT RD STE A
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City | LORAIN
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State | OH
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Zip | 44053-2139
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Country | US
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Telephone | 440-989-2066
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Fax | 440-989-1153
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Provider Business Mailing Address
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Address Line | 26953 SOUTHWOOD LN
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City | OLMSTED FALLS
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State | OH
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Zip | 44138-1156
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Country | US
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Telephone | 440-427-9596
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Fax | 440-989-1153
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50-000885
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License Number State | OH
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