Healthcare Provider Details

I. General information

NPI: 1841312212
Provider Name (Legal Business Name): CHRISTY M OLOFSSON O.T., P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY M. MCMANUS O.T., P.T.A.

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 S WESTERN AVE
CHICAGO IL
60643-1917
US

IV. Provider business mailing address

10201 S WESTERN AVE
CHICAGO IL
60643-1917
US

V. Phone/Fax

Practice location:
  • Phone: 773-779-7273
  • Fax: 773-779-7298
Mailing address:
  • Phone: 773-779-7273
  • Fax: 773-779-7298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160004410
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056002420
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: