Provider Demographics
NPI:1891490116
Name:ROEHL, OLIVIA RENEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:RENEE
Last Name:ROEHL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 APPLETREE LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-2645
Mailing Address - Country:US
Mailing Address - Phone:920-450-4034
Mailing Address - Fax:
Practice Address - Street 1:1101 E SOUTH RIVER ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-2223
Practice Address - Country:US
Practice Address - Phone:920-830-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8169-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist