Provider Demographics
NPI:1841312212
Name:OLOFSSON, CHRISTY M (OT, PTA)
Entity type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:M
Last Name:OLOFSSON
Suffix:
Gender:F
Credentials:OT, PTA
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:M
Other - Last Name:MCMANUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT, PTA
Mailing Address - Street 1:10201 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1917
Mailing Address - Country:US
Mailing Address - Phone:773-779-7273
Mailing Address - Fax:773-779-7298
Practice Address - Street 1:10201 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1917
Practice Address - Country:US
Practice Address - Phone:773-779-7273
Practice Address - Fax:773-779-7298
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160004410225200000X
IL056002420225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001618872OtherBLUE CROSS BLUE SHEILD