Provider Demographics
NPI:1124566849
Name:OLSON, JEANETTE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 GREENHILLS DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2717
Mailing Address - Country:US
Mailing Address - Phone:734-546-2239
Mailing Address - Fax:
Practice Address - Street 1:26400 W 12 MILE RD STE 25
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1774
Practice Address - Country:US
Practice Address - Phone:248-565-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist