Provider Demographics
NPI:1306357561
Name:OLBROT, MARY THERESE (OTRL)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:THERESE
Last Name:OLBROT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5146 BURNING TREE RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3804
Mailing Address - Country:US
Mailing Address - Phone:269-377-5506
Mailing Address - Fax:
Practice Address - Street 1:5146 BURNING TREE RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3804
Practice Address - Country:US
Practice Address - Phone:269-615-5297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004121225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty