Provider Demographics
NPI:1265888796
Name:ZAVODNY-OLSON, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:ZAVODNY-OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 STATE ROAD 16
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3013
Mailing Address - Country:US
Mailing Address - Phone:715-505-6017
Mailing Address - Fax:
Practice Address - Street 1:N818 STATE HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:STODDARD
Practice Address - State:WI
Practice Address - Zip Code:54658-9777
Practice Address - Country:US
Practice Address - Phone:715-505-6017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225X00000X
WI5211224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5211OtherOCCUPATIONAL THERAPY ASSISTANT