Provider Demographics
NPI:1497123483
Name:OLSON, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:OLSON
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 1:6520 W LAYTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4572
Mailing Address - Country:US
Mailing Address - Phone:414-858-1360
Mailing Address - Fax:414-858-1370
Practice Address - Street 1:S71W23325 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BIG BEND
Practice Address - State:WI
Practice Address - Zip Code:53103-9495
Practice Address - Country:US
Practice Address - Phone:262-662-9775
Practice Address - Fax:262-662-9773
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13128-24225100000X
WI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist