Provider Demographics
NPI:1386338390
Name:TRULL, OLIVIA AUSTEN (OTR/L)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:AUSTEN
Last Name:TRULL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 RAINTREE LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3837
Mailing Address - Country:US
Mailing Address - Phone:864-293-4383
Mailing Address - Fax:
Practice Address - Street 1:4026 S NC 11 HWY
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-6110
Practice Address - Country:US
Practice Address - Phone:910-285-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15948225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist