Provider Demographics
NPI:1184293706
Name:OLCOTT, ABIGAIL JEAN (RD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JEAN
Last Name:OLCOTT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13032 71ST ST APT 7118
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-8464
Mailing Address - Country:US
Mailing Address - Phone:309-397-6406
Mailing Address - Fax:
Practice Address - Street 1:13032 71ST ST APT 7118
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-8464
Practice Address - Country:US
Practice Address - Phone:309-397-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered