Provider Demographics
NPI:1427699016
Name:OSBORN, OLIVIA GRACE (LMT)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:GRACE
Last Name:OSBORN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:636 PLANK RD STE 108A
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2046
Mailing Address - Country:US
Mailing Address - Phone:838-250-4417
Mailing Address - Fax:518-280-5483
Practice Address - Street 1:636 PLANK RD STE 108A
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2046
Practice Address - Country:US
Practice Address - Phone:838-250-4417
Practice Address - Fax:518-280-5483
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029982225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist