Provider Demographics
NPI:1952029225
Name:OLENIK, JACKIE RENEE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:RENEE
Last Name:OLENIK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BOHICA RD
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8491
Mailing Address - Country:US
Mailing Address - Phone:307-899-3293
Mailing Address - Fax:
Practice Address - Street 1:3101 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-7736
Practice Address - Country:US
Practice Address - Phone:307-587-4279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant