MEDICARE: OLIVIA DRAKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1881526143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA DRAKE

Provider Business Mailing Address
First Line	:	1 OHIO UNIVERSITY DEPT OF PSYCHOLOGY
Second Line	:	PORTER HALL ROOM 002
City	:	ATHENS
State	:	OH
Zip	:	45701
Country	:	US
Telephone Number	:	740-593-0902
Fax Number	:	740-593-4790

Provider Business Practice Location Address
First Line	:	1 OHIO UNIVERSITY DEPT OF PSYCHOLOGY
Second Line	:	PORTER HALL ROOM 002
City	:	ATHENS
State	:	OH
Zip	:	45701
Country	:	US
Telephone Number	:	740-593-0902
Fax Number	:	740-593-4790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ OLIVIA DRAKE ” Practice Location

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