1720054752 NPI number — MRS. MELISSA CHRIST OLSON OTR/L, CLT

Table of content: MRS. MELISSA CHRIST OLSON OTR/L, CLT (NPI 1720054752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720054752 NPI number — MRS. MELISSA CHRIST OLSON OTR/L, CLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSON
Provider First Name:
MELISSA
Provider Middle Name:
CHRIST
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CLT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720054752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15999 CRANE ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55304-4595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-432-2728
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8290 UNIVERSITY AVE NE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FRIDLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55432-1847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-786-9543
Provider Business Practice Location Address Fax Number:
763-786-3320
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  102767 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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