Provider Demographics
NPI:1386253813
Name:MAXINOSKI, OLIVIA KATHERINE (COTA)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:KATHERINE
Last Name:MAXINOSKI
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 1:2317 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5965
Mailing Address - Country:US
Mailing Address - Phone:715-897-0533
Mailing Address - Fax:
Practice Address - Street 1:614 S ROCK AVE
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1936
Practice Address - Country:US
Practice Address - Phone:608-637-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant