Provider Demographics
NPI:1043098593
Name:OLUICH, STEPHEN NELSON
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:NELSON
Last Name:OLUICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 16TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-2031
Mailing Address - Country:US
Mailing Address - Phone:330-268-8832
Mailing Address - Fax:
Practice Address - Street 1:1130 ARDMORE AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-2145
Practice Address - Country:US
Practice Address - Phone:330-323-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHST1303273747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant