Provider Demographics
NPI:1134425523
Name:OLSON, REVEE MARIE (MSOTR/L)
Entity type:Individual
Prefix:
First Name:REVEE
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 GIDDINGS AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-1707
Mailing Address - Country:US
Mailing Address - Phone:920-550-5254
Mailing Address - Fax:
Practice Address - Street 1:531 GIDDINGS AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-1707
Practice Address - Country:US
Practice Address - Phone:920-550-5254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4961-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist