Provider Demographics
NPI:1629872577
Name:HENRY, OLIVIA BLAINE (OTR)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:BLAINE
Last Name:HENRY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 TANNER RD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-9555
Mailing Address - Country:US
Mailing Address - Phone:859-308-9664
Mailing Address - Fax:
Practice Address - Street 1:4009 SELIGMAN DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3087
Practice Address - Country:US
Practice Address - Phone:859-308-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY529932225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist