Individual
KELLYE W OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, CPAMS
Contact information
Practice address
17201 SE 109TH TERRACE RD, SUMMERFIELD, FL 34491-9019
(775) 367-6937
(850) 308-7191
Mailing address
9926 SE SUNSET HARBOR RD, SUMMERFIELD, FL 34491-4504
(859) 433-1830
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
R3423
KY
225XH1200X
Hand Occupational Therapist
OT18697
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000480057
ANTHEM BCBS
KY
01
—
0007162160
AETNA
KY
01
—
61-1335045
HUMANA
KY
Enumeration date
06/14/2006
Last updated
07/31/2024
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