Provider Demographics
NPI:1174314512
Name:SMITH, OLIVIA (ST)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12057
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29504-2057
Mailing Address - Country:US
Mailing Address - Phone:843-229-5813
Mailing Address - Fax:843-662-3612
Practice Address - Street 1:1261 CELEBRATION BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5499
Practice Address - Country:US
Practice Address - Phone:843-229-5813
Practice Address - Fax:843-662-3612
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist