Healthcare Provider Details

I. General information

NPI: 1942146105
Provider Name (Legal Business Name): OLIVIA KAY JOYCE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 SYCAMORE ST
SAUK CITY WI
53583-1013
US

IV. Provider business mailing address

737 8TH ST
PRAIRIE DU SAC WI
53578-1057
US

V. Phone/Fax

Practice location:
  • Phone: 608-643-3383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4185-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: