Provider Demographics
NPI:1639651094
Name:OLSON, ANN MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:CONNELLHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:3640 SARATOG AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-969-9360
Mailing Address - Fax:
Practice Address - Street 1:3450 SARATOGA AVE.
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-969-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-02
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.000638224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant