Provider Demographics
NPI:1023223153
Name:OLSON, ELEANORE A (OT)
Entity Type:Individual
Prefix:
First Name:ELEANORE
Middle Name:A
Last Name:OLSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:FALL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:98024-0751
Mailing Address - Country:US
Mailing Address - Phone:425-830-8768
Mailing Address - Fax:425-952-0451
Practice Address - Street 1:3913 324TH AVE SE
Practice Address - Street 2:
Practice Address - City:FALL CITY
Practice Address - State:WA
Practice Address - Zip Code:98024-7700
Practice Address - Country:US
Practice Address - Phone:425-830-8768
Practice Address - Fax:425-952-0451
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004215225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist