Individual
MS. JENNIFER OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.O.T.A.
Contact information
Practice address
1615 SUNSET AVE, WAUKEGAN, IL 60087-3810
(847) 244-6700
Mailing address
12812 71ST ST APT 618, KENOSHA, WI 53142-8433
(262) 993-6385
(800) 918-8512
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.004171
IL
224Z00000X
Occupational Therapy Assistant
OTA13956
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912303215
—
IL
Enumeration date
11/13/2014
Last updated
04/18/2022
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