Healthcare Provider Details

I. General information

NPI: 1164354023
Provider Name (Legal Business Name): O2 LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 HERITAGE BLVD
WEST SALEM WI
54669-9418
US

IV. Provider business mailing address

1580 HERITAGE BLVD
WEST SALEM WI
54669-9418
US

V. Phone/Fax

Practice location:
  • Phone: 608-668-6940
  • Fax:
Mailing address:
  • Phone: 608-668-6940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY OZANNE
Title or Position: OWNER
Credential:
Phone: 608-668-6940