Provider Demographics
NPI:1093574907
Name:OLSON, BERYL JOLENE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:BERYL
Middle Name:JOLENE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3855
Mailing Address - Country:US
Mailing Address - Phone:605-668-8292
Mailing Address - Fax:
Practice Address - Street 1:501 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3855
Practice Address - Country:US
Practice Address - Phone:605-668-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0620225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist