Provider Demographics
NPI:1215626403
Name:SAMMARTINO, OLIVIA NOEL
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:NOEL
Last Name:SAMMARTINO
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 1:1772 BENTGRASS LN
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8537
Mailing Address - Country:US
Mailing Address - Phone:803-627-1080
Mailing Address - Fax:
Practice Address - Street 1:1450 ANDERSON RD S
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-9002
Practice Address - Country:US
Practice Address - Phone:803-324-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician