Provider Demographics
NPI:1215792288
Name:OLIVAREZ, NICOLE DANIELLE (LMT)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:DANIELLE
Last Name:OLIVAREZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7089 TANDEMS WAY
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-3448
Mailing Address - Country:US
Mailing Address - Phone:757-334-1523
Mailing Address - Fax:
Practice Address - Street 1:7089 TANDEMS WAY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3448
Practice Address - Country:US
Practice Address - Phone:757-334-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019007685225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist