Provider Demographics
NPI:1073262390
Name:OLSON, MELISSA (IS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:IS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1262 STEVENS DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-3577
Mailing Address - Country:US
Mailing Address - Phone:208-521-5816
Mailing Address - Fax:
Practice Address - Street 1:1262 STEVENS DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-3577
Practice Address - Country:US
Practice Address - Phone:208-521-5816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty