Provider Demographics
NPI:1396505897
Name:BRESEMAN, OLIVIA P
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:P
Last Name:BRESEMAN
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 1:1859 S SUNNYVALE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-3440
Mailing Address - Country:US
Mailing Address - Phone:602-402-0694
Mailing Address - Fax:
Practice Address - Street 1:1859 S SUNNYVALE AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3440
Practice Address - Country:US
Practice Address - Phone:602-402-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant