Individual
OLIVIA PARK
Active
Individual
OLIVIA PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
01076676A
IN
208100000X
Physical Medicine & Rehabilitation Physician
Primary
72450-20
WI
2081P0004X
Spinal Cord Injury Medicine Physician
72450-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100096196
—
WI
Enumeration date
03/29/2011
Last updated
12/03/2025
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