Individual
SCOTT WADE OLENICZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
215 N WEBSTER AVE, GREEN BAY, WI 54301-4813
(920) 431-5588
(920) 445-7090
Mailing address
3446 EDINBURGH RD, GREEN BAY, WI 54311-7284
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3259-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40814600
—
WI
Enumeration date
05/15/2007
Last updated
10/29/2019
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