MEDICARE: MR. JOSEPH J OLSZEWSKI MS LAT CSCS

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	2255A2300X	Athletic Trainer	524039	WI

General Provider Information

NPI Number	:	1639202971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH J OLSZEWSKI MS LAT CSCS

Provider Business Mailing Address
First Line	:	4506 79TH ST
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142
Country	:	US
Telephone Number	:	262-705-1203
Fax Number	:

Provider Business Practice Location Address
First Line	:	4506 79TH ST
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-4519
Country	:	US
Telephone Number	:	262-705-1203
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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