Provider Demographics
NPI:1124657622
Name:MICHOT, OLIVIA ALEXANDRA
Entity type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:ALEXANDRA
Last Name:MICHOT
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 1:5849 EAGLE CAY LN
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2601
Mailing Address - Country:US
Mailing Address - Phone:954-675-2605
Mailing Address - Fax:
Practice Address - Street 1:8355 WEST FLAGLER STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:954-675-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst