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General NPI Number Information
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NPI Number | 1457164899
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Entity Type | Individual
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Provider Name | OLIVIA NICOLE HORTON
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Gender | Female
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 260 SUNRISE BLVD
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City | ROMNEY
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State | WV
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Zip | 26757-6345
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Country | US
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Telephone | 130-482-2752
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Fax |
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Provider Business Mailing Address
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Address Line | 160 ROCKET CENTER RD
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City | KEYSER
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State | WV
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Zip | 26726-6680
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Country | US
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Telephone | 814-494-4293
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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 | 002922
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License Number State | WV
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