Not Enrolled Provider – OLTL Community HealthChoices – Direct Service Provider Completion

Congratulations on completing the OLTL Community HealthChoices – Direct Service Provider online training. To register your completion of the training, please complete the fields below.

Your Name*
First Last
Job Title*
Organization Name*
Is Your Organization a:*
- Direct Service Provider not enrolled with OLTL
- Service Coordination Entity
Provider Number or FEIN Number (9 Characters)*
Email*