MEDICARE: JULIET OLALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	6484	CT

General Provider Information

NPI Number	:	1124515051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIET OLALA

Provider Business Mailing Address
First Line	:	27 GOVERNOR ST
Second Line	:
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-4608
Country	:	US
Telephone Number	:	864-906-0877
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 GOVERNOR ST
Second Line	:
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-4608
Country	:	US
Telephone Number	:	864-906-0877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	10/03/2024

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