Provider Demographics
NPI:1629641832
Name:KING, OLIVIA KATHRYN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KATHRYN
Last Name:KING
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 1/2 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-1645
Mailing Address - Country:US
Mailing Address - Phone:724-614-8643
Mailing Address - Fax:
Practice Address - Street 1:706 EISENHOWER BLVD STE 3
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3527
Practice Address - Country:US
Practice Address - Phone:812-266-6651
Practice Address - Fax:814-269-5706
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017837225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist