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General NPI Number Information
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NPI Number | 1871193086
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Entity Type | Individual
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Provider Name | TROY OLSHESKI
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Gender | Male
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 1970 EASTON TPKE
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City | LAKE ARIEL
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State | PA
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Zip | 18436-4661
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Country | US
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Telephone | 570-406-9078
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Fax |
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Provider Business Mailing Address
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Address Line | 200 KENNEDY DR APT 2
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City | ARCHBALD
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State | PA
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Zip | 18403-1541
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Country | US
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Telephone | 570-406-9078
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT006240
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License Number State | PA
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