Provider Demographics
NPI:1205392412
Name:OLTON, ALYSSA MARIE POWELL (CO)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE POWELL
Last Name:OLTON
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MARIE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CO
Mailing Address - Street 1:1516 HUDSON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3046
Mailing Address - Country:US
Mailing Address - Phone:360-423-6049
Mailing Address - Fax:
Practice Address - Street 1:2621 NE 134TH ST STE 120
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3036
Practice Address - Country:US
Practice Address - Phone:360-574-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist