Provider Demographics
NPI:1265798995
Name:OLERUD, KASSI EVELYN (MS/OTR)
Entity type:Individual
Prefix:
First Name:KASSI
Middle Name:EVELYN
Last Name:OLERUD
Suffix:
Gender:F
Credentials:MS/OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 PINE PLACE
Mailing Address - Street 2:
Mailing Address - City:WESTBY
Mailing Address - State:WI
Mailing Address - Zip Code:54667
Mailing Address - Country:US
Mailing Address - Phone:608-790-6640
Mailing Address - Fax:
Practice Address - Street 1:E7404A COUNTY ROAD BB
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-7502
Practice Address - Country:US
Practice Address - Phone:608-637-5422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5131-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI22Medicaid
WI1265798995Medicaid