Provider Demographics
NPI:1598191009
Name:KELLAR, OLIVIA M (LAC, MACOM, LMT)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:M
Last Name:KELLAR
Suffix:
Gender:F
Credentials:LAC, MACOM, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 25TH AVE N STE 521
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1636
Mailing Address - Country:US
Mailing Address - Phone:615-647-7226
Mailing Address - Fax:
Practice Address - Street 1:636 SE 49TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1728
Practice Address - Country:US
Practice Address - Phone:971-506-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17162225700000X
TN459171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR17162OtherOBMT LICENSE OREGON LMT
TN459OtherLICENSED ACUPUNCTURIST L.AC., M.AC.O.M.