Provider Demographics
NPI:1679258214
Name:ALLEN, OLIVIA JACQUELINE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JACQUELINE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-6130
Mailing Address - Country:US
Mailing Address - Phone:214-682-3789
Mailing Address - Fax:
Practice Address - Street 1:807 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-6130
Practice Address - Country:US
Practice Address - Phone:214-682-3789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer