Provider Demographics
NPI:1861793622
Name:OLSON, CHASSIE LE (LPTA)
Entity type:Individual
Prefix:
First Name:CHASSIE
Middle Name:LE
Last Name:OLSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W9319 COUNTY ROAD X
Mailing Address - Street 2:
Mailing Address - City:CRIVITZ
Mailing Address - State:WI
Mailing Address - Zip Code:54114-8546
Mailing Address - Country:US
Mailing Address - Phone:920-606-5292
Mailing Address - Fax:
Practice Address - Street 1:903 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CRIVITZ
Practice Address - State:WI
Practice Address - Zip Code:54114-1619
Practice Address - Country:US
Practice Address - Phone:715-854-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI742-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant