Provider Demographics
NPI:1104571611
Name:CHAVEZ OLVERA, THANIA
Entity type:Individual
Prefix:
First Name:THANIA
Middle Name:
Last Name:CHAVEZ OLVERA
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:PO BOX 2998
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-6998
Mailing Address - Country:US
Mailing Address - Phone:863-599-4499
Mailing Address - Fax:
Practice Address - Street 1:680 MAGNOLIA LN
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-8494
Practice Address - Country:US
Practice Address - Phone:863-599-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician