Provider Demographics
NPI:1194496091
Name:FENSTERMAKER, OLIVIA ST ROMAIN (OTR)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ST ROMAIN
Last Name:FENSTERMAKER
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 1:202 LEICESTER LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4863
Mailing Address - Country:US
Mailing Address - Phone:225-610-9491
Mailing Address - Fax:
Practice Address - Street 1:12605 EAST FWY STE 212
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5619
Practice Address - Country:US
Practice Address - Phone:713-453-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122039225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist