Healthcare Provider Details

I. General information

NPI: 1427091883
Provider Name (Legal Business Name): KELLYE W OLSON OTR/L, CPAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLYE WOODWARD BURCH OTD, OTR/L, CHT

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17201 SE 109TH TERRACE RD
SUMMERFIELD FL
34491-9019
US

IV. Provider business mailing address

9926 SE SUNSET HARBOR RD
SUMMERFIELD FL
34491-4504
US

V. Phone/Fax

Practice location:
  • Phone: 775-367-6937
  • Fax: 850-308-7191
Mailing address:
  • Phone: 859-433-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT18697
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR3423
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: