Provider Demographics
NPI:1275427684
Name:KORIAKOVA, OLGA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KORIAKOVA
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 1:250 174TH ST APT 801
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3348
Mailing Address - Country:US
Mailing Address - Phone:475-439-3449
Mailing Address - Fax:
Practice Address - Street 1:250 174TH ST APT 801
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3348
Practice Address - Country:US
Practice Address - Phone:475-439-3449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-442687106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician