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General NPI Number Information
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NPI Number | 1720746605
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Entity Type | Individual
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Provider Name | JOSE ENRIQUE OLIVENCIA OTR/L
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Gender | Male
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 2100 MILLVALE RD
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City | LOUISVILLE
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State | KY
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Zip | 40205-1604
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Country | US
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Telephone | 502-451-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 206 HIDDEN OAK PL
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City | LOUISVILLE
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State | KY
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Zip | 40222-4866
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Country | US
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Telephone | 502-608-5978
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 131789
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License Number State | KY
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