Provider Demographics
NPI:1427091883
Name:OLSON, KELLYE W (OTR/L, CPAMS)
Entity type:Individual
Prefix:
First Name:KELLYE
Middle Name:W
Last Name:OLSON
Suffix:
Gender:F
Credentials:OTR/L, CPAMS
Other - Prefix:
Other - First Name:KELLYE
Other - Middle Name:WOODWARD
Other - Last Name:BURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L, CHT
Mailing Address - Street 1:9926 SE SUNSET HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-4504
Mailing Address - Country:US
Mailing Address - Phone:859-433-1830
Mailing Address - Fax:
Practice Address - Street 1:17201 SE 109TH TERRACE RD
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-9019
Practice Address - Country:US
Practice Address - Phone:775-367-6937
Practice Address - Fax:850-308-7191
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18697225XH1200X
KYR3423225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000480057OtherANTHEM BCBS
KY61-1335045OtherHUMANA
KY0007162160OtherAETNA
KY61-1335045OtherUNITED HEALTHCARE
KY0007162160OtherAETNA