Doctor Name: | ROBERT EDWARD OLT |
NPI Number: | 1386067213 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 071.008386 |
Business Practice Address: | 588 S Plum St Havana, IL - 626441374 |
Business Phone Number: | 3092537611 |
Business Fax Number: | |
Mailing Address: | 588 S Plum St, HAVANA |
State: | IL |
Postal Code: | 626441374 |
Phone Number: | 3092537611 |
Fax Number: | |
NPI Enumeration Date: | 01/29/2014 |
NPI Last Update Date: | 01/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 071.008386 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |