Provider Demographics
NPI:1275365629
Name:WELCH, OLIVIA KATHERINE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KATHERINE
Last Name:WELCH
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 1:136 VERANDA LN
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-7752
Mailing Address - Country:US
Mailing Address - Phone:478-787-2940
Mailing Address - Fax:
Practice Address - Street 1:136 VERANDA LN
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-7752
Practice Address - Country:US
Practice Address - Phone:478-787-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer