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General NPI Number Information
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NPI Number | 1104870708
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Entity Type | Individual
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Provider Name | TAMARA L. OLT M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 6915 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61614-2850
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Country | US
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Telephone | 309-692-2805
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Fax | 309-692-1913
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Provider Business Mailing Address
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Address Line | 6915 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61614-2850
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Country | US
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Telephone | 309-692-2805
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Fax | 309-692-1913
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 036089480
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 036089480
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License Number State | IL
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