Provider Demographics
NPI:1083655278
Name:OLSON, NANCY DARCY D (OTR)
Entity Type:Individual
Prefix:
First Name:NANCY DARCY
Middle Name:D
Last Name:OLSON
Suffix:
Gender:F
Credentials:OTR
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 727
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56502-0727
Mailing Address - Country:US
Mailing Address - Phone:218-844-2300
Mailing Address - Fax:218-844-2444
Practice Address - Street 1:125 FRAZEE ST E
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3501
Practice Address - Country:US
Practice Address - Phone:218-844-2300
Practice Address - Fax:218-844-2444
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102115225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNDA9031015523OtherPREFERRED ONE #
MN17855OtherNDBS #
ND65D02OLOtherMNBS #
ND39A42OLOtherMNBS #
FM6401687OtherMEDICA #
MN6401691OtherMEDICA #
MN65D03OLOtherMNBS #
MN65D04OLOtherMNBS #
MN974269OtherAMERICA'S PPO/ARAZ #
MN51457Medicaid
ND6401688OtherMEDICA #
ND6401690OtherMEDICA #
ND39A42OLOtherMNBS #
MN6401691OtherMEDICA #
ND17853Medicare ID - Type UnspecifiedND MEDICARE #