Provider Demographics
NPI:1225348667
Name:OLSEN, SCOTT (LMP, NCTMB)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:OLSEN
Suffix:
Gender:M
Credentials:LMP, NCTMB
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 254
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-0254
Mailing Address - Country:US
Mailing Address - Phone:425-615-6134
Mailing Address - Fax:
Practice Address - Street 1:118 105TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5913
Practice Address - Country:US
Practice Address - Phone:425-615-6134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60169798225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist