Provider Demographics
NPI:1043886575
Name:KOUKOUI, OLIVIA QUEEN
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:QUEEN
Last Name:KOUKOUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CRAIN HWY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8804
Mailing Address - Country:US
Mailing Address - Phone:301-408-8970
Mailing Address - Fax:
Practice Address - Street 1:155 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8804
Practice Address - Country:US
Practice Address - Phone:301-408-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No172A00000XOther Service ProvidersDriver
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)