Provider Demographics
NPI:1104604909
Name:JAMESON, OLIVIA (PTA)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:JAMESON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:56 BENNER LANE
Mailing Address - Street 2:
Mailing Address - City:NOBLEBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04555
Mailing Address - Country:US
Mailing Address - Phone:207-975-9542
Mailing Address - Fax:
Practice Address - Street 1:91 CAMDEN ST STE 107
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2458
Practice Address - Country:US
Practice Address - Phone:207-596-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant