Provider Demographics
NPI:1851024863
Name:SMALLWOOD, OLIVIA
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:SMALLWOOD
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 1:3228 SENECA TRL
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:WV
Mailing Address - Zip Code:26283-8813
Mailing Address - Country:US
Mailing Address - Phone:681-298-1112
Mailing Address - Fax:
Practice Address - Street 1:3228 SENECA TRL
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:WV
Practice Address - Zip Code:26283-8813
Practice Address - Country:US
Practice Address - Phone:681-298-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator