Provider Demographics
NPI:1124294996
Name:OLBY, VALERIE MARIE (COTA)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:MARIE
Last Name:OLBY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49163 STATE HIGHWAY 112
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-4236
Mailing Address - Country:US
Mailing Address - Phone:715-685-9596
Mailing Address - Fax:
Practice Address - Street 1:49163 STATE HIGHWAY 112
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-4236
Practice Address - Country:US
Practice Address - Phone:715-685-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2010-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41056500Medicaid