Provider Demographics
NPI:1508563719
Name:OLAH, JESSIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:OLAH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4577 GOLD MEDAL PT APT 210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7365
Mailing Address - Country:US
Mailing Address - Phone:619-977-5294
Mailing Address - Fax:
Practice Address - Street 1:1401 PHAY AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2398
Practice Address - Country:US
Practice Address - Phone:719-275-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTA-1632224Z00000X
OR449293224Z00000X
COOTA.0001424224Z00000X
CAOTA6012224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
F3S134363512001OtherBLUE CROSS BLUE SHIELD