Healthcare Provider Details

I. General information

NPI: 1265888796
Provider Name (Legal Business Name): KATIE ZAVODNY-OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 09/13/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N818 STATE HIGHWAY 35
STODDARD WI
54658-9777
US

IV. Provider business mailing address

2346 STATE ROAD 16
LA CROSSE WI
54601-3013
US

V. Phone/Fax

Practice location:
  • Phone: 715-505-6017
  • Fax:
Mailing address:
  • Phone: 715-505-6017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5211
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: