Provider Demographics
NPI:1578357679
Name:OLMSTEAD, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:OLMSTEAD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29803 COUNTY HWY W
Mailing Address - Street 2:
Mailing Address - City:HOLCOMBE
Mailing Address - State:WI
Mailing Address - Zip Code:54745-4420
Mailing Address - Country:US
Mailing Address - Phone:715-312-0969
Mailing Address - Fax:
Practice Address - Street 1:29803 COUNTY HWY W
Practice Address - Street 2:
Practice Address - City:HOLCOMBE
Practice Address - State:WI
Practice Address - Zip Code:54745-4420
Practice Address - Country:US
Practice Address - Phone:715-312-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI970845133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered