Healthcare Provider Details

I. General information

NPI: 1386881936
Provider Name (Legal Business Name): SUMMER MARIE OLMSTEAD OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2009
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 RIVERSIDE DR
BATTLE CREEK MI
49015-4429
US

IV. Provider business mailing address

506 RIVERSIDE DR
BATTLE CREEK MI
49015-4429
US

V. Phone/Fax

Practice location:
  • Phone: 269-963-3072
  • Fax:
Mailing address:
  • Phone: 269-963-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201006374
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: