Provider Demographics
NPI:1316068091
Name:OLSON, CATHY M (PTA)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:M
Last Name:OLSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:CATHY
Other - Middle Name:M
Other - Last Name:SHEAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:N341 TAMARACK DR.
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915
Mailing Address - Country:US
Mailing Address - Phone:920-687-9074
Mailing Address - Fax:
Practice Address - Street 1:3305C NORTH BALLARD RD.
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-9001
Practice Address - Country:US
Practice Address - Phone:920-735-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI388-019174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist