Provider Demographics
NPI:1831887843
Name:CORY, OLIVIA MARIA
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIA
Last Name:CORY
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 1:35 S DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954-2020
Mailing Address - Country:US
Mailing Address - Phone:570-900-8947
Mailing Address - Fax:
Practice Address - Street 1:35 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954-2020
Practice Address - Country:US
Practice Address - Phone:570-900-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0083682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer