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General NPI Number Information
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NPI Number | 1780368787
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Entity Type | Individual
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Provider Name | OLIVIA LAIR LSW
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Gender | Female
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 4977 NORTHCUTT PL
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City | DAYTON
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State | OH
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Zip | 45414-3839
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Country | US
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Telephone | 937-387-6395
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Fax |
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Provider Business Mailing Address
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Address Line | 421 SHAWNEE RUN APT C
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City | WEST CARROLLTON
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State | OH
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Zip | 45449-3918
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Country | US
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Telephone | 937-203-7877
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S2309368
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License Number State | OH
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