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General NPI Number Information
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NPI Number | 1235839697
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Entity Type | Individual
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Provider Name | OLIVIA ANN DEITERING
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 500 5TH ST
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City | BROOKINGS
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State | OR
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Zip | 97415-9702
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Country | US
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Telephone | 419-788-4247
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Fax |
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Provider Business Mailing Address
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Address Line | 5665 TOWNSHIP ROAD 93
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City | MCCOMB
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State | OH
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Zip | 45858
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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