Provider Demographics
NPI:1699349068
Name:PARK, OLIVIA CHUNG-EUN (OTR/L)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CHUNG-EUN
Last Name:PARK
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 1:5530 WISCONSIN AVE STE 1650
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4323
Mailing Address - Country:US
Mailing Address - Phone:301-986-9100
Mailing Address - Fax:301-657-8229
Practice Address - Street 1:5530 WISCONSIN AVE STE 1650
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4323
Practice Address - Country:US
Practice Address - Phone:301-986-9100
Practice Address - Fax:301-657-8229
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09293225X00000X, 225XH1200X
DCOT200001195225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD09293OtherMD LICENSE NUMBER