Healthcare Provider Details

I. General information

NPI: 1609664978
Provider Name (Legal Business Name): MARLEE OLMO AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 HAZARD AVE STE 204
ENFIELD CT
06082-4566
US

IV. Provider business mailing address

146 HAZARD AVE STE 204
ENFIELD CT
06082-4566
US

V. Phone/Fax

Practice location:
  • Phone: 860-763-3243
  • Fax: 860-763-3244
Mailing address:
  • Phone: 860-763-3243
  • Fax: 860-763-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number809
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number809
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number809
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number809
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number809
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: