Provider Demographics
NPI:1477789121
Name:OLSON, KARI JO (PTA)
Entity Type:Individual
Prefix:
First Name:KARI JO
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 PLOVER RD
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-2155
Mailing Address - Country:US
Mailing Address - Phone:715-423-5423
Mailing Address - Fax:715-423-1532
Practice Address - Street 1:503 S CHERRY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4276
Practice Address - Country:US
Practice Address - Phone:715-387-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1577019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant