Provider Demographics
NPI:1083221030
Name:OLSON, KEITH ALAN
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ALAN
Last Name:OLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6488 AMBER CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1179
Mailing Address - Country:US
Mailing Address - Phone:513-255-4313
Mailing Address - Fax:
Practice Address - Street 1:6488 AMBER CT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1179
Practice Address - Country:US
Practice Address - Phone:513-255-4313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services