Healthcare Provider Details

I. General information

NPI: 1487595294
Provider Name (Legal Business Name): ZOE MAE OLSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 DOUGLAS RD
OSWEGO IL
60543-5106
US

IV. Provider business mailing address

1117 DANIEL LN
SANDWICH IL
60548-1098
US

V. Phone/Fax

Practice location:
  • Phone: 331-216-0100
  • Fax:
Mailing address:
  • Phone: 815-909-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: