Provider Demographics
NPI:1255226726
Name:DRISCOLL, OLIVIA RENEE INFANTE (CTRS)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:RENEE INFANTE
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8073 CAMERON CT SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9581
Mailing Address - Country:US
Mailing Address - Phone:616-916-6647
Mailing Address - Fax:
Practice Address - Street 1:8073 CAMERON CT SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-9581
Practice Address - Country:US
Practice Address - Phone:616-916-6647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI87901225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist