Provider Demographics
NPI:1982229654
Name:MYERS, OLIVIA S (RD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:S
Last Name:MYERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:S
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1268 CITY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-3612
Mailing Address - Country:US
Mailing Address - Phone:614-551-7402
Mailing Address - Fax:
Practice Address - Street 1:1747 OLENTANGY RIVER RD # 1273
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1453
Practice Address - Country:US
Practice Address - Phone:614-551-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD09124133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered