Provider Demographics
NPI:1881346609
Name:OLLEY, ELIZABETH A
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:OLLEY
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 1:7 CEDARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-2603
Mailing Address - Country:US
Mailing Address - Phone:262-497-8099
Mailing Address - Fax:
Practice Address - Street 1:13200 GLOBE DR STE 206
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1615
Practice Address - Country:US
Practice Address - Phone:262-497-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5211225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist