Provider Demographics
NPI:1215613922
Name:TEAGUE, OLIVIA L (ATC, LAT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:L
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HABERSAC AVE
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7554
Mailing Address - Country:US
Mailing Address - Phone:614-800-7684
Mailing Address - Fax:
Practice Address - Street 1:49 HABERSAC AVE
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7554
Practice Address - Country:US
Practice Address - Phone:614-800-7684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0068382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer