Individual
OLIVIA VITA-FARNSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
288 LAKEVIEW DRIVE, MISSISSIPPI STATE, MS 39762
(662) 325-2165
(662) 325-5145
Mailing address
PO BOX 5327, MISSISSIPPI STATE, MS 39762-5327
(662) 325-2165
(662) 325-5145
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0126003204
VA
2255A2300X
Athletic Trainer
Primary
A992
MS
Other
Enumeration date
07/22/2014
Last updated
07/03/2020
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