Provider Demographics
NPI:1639916679
Name:OLIVIER, KAITLIN SHAE
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:SHAE
Last Name:OLIVIER
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 1:16602 HUNTING VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1054
Mailing Address - Country:US
Mailing Address - Phone:210-844-1497
Mailing Address - Fax:
Practice Address - Street 1:5210 THOUSAND OAKS DR STE 1301
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6974
Practice Address - Country:US
Practice Address - Phone:210-714-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician