Provider Demographics
NPI:1396304069
Name:OLIVERI, REAGAN (ATC)
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:
Last Name:OLIVERI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 CANDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-2124
Mailing Address - Country:US
Mailing Address - Phone:856-464-6899
Mailing Address - Fax:
Practice Address - Street 1:81 CANDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:NJ
Practice Address - Zip Code:08051-2124
Practice Address - Country:US
Practice Address - Phone:856-464-6899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
22OtherRESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS