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General NPI Number Information
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NPI Number | 1992310528
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Entity Type | Individual
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Provider Name | OLIVIA ROMITO OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 1108 CHURCH ST
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City | SHELBY
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State | MS
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Zip | 38774-2200
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Country | US
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Telephone | 662-398-5117
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Fax |
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Provider Business Mailing Address
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Address Line | 13025 OAK RIDGE DR
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-6043
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Country | US
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Telephone | 901-517-9595
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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 | OT-3815
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License Number State | MS
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